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9,(4tt STATE I0 NUMBER 00000001011001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( l 06 AMENDED PERMIT ( MCHANGE (NO SURCHARGE) <br /> IOWNER <br /> NAME(CORPOPATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> HENRY J. KOLNER, BEVERLY A. KO ( ) 01 FED ( ) 02 STATE ( 1 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 3300 N. EL DORADO STOCKTON CA 95204 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> EL DORADO CAR WASH HENRY J. KOLNER <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 3300 N. EL DORADO <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95204 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 3300 N. EL DORADO STOCKTON CA 95204 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-465-7646 (X) Ol GASOLINE STATION l ) 02 OTHER <br /> NUMBER OF CONTAINERS { RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 2 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGXTS: NAME(IAST NAME FIRST) AND PHONE W/AREA CODE <br /> KOLHER, HENRY J. 209-465-7646 KOLNER, HENRY J. 209-474-8251 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> 0. CONTAINER CAPACITY: 8000 GALLONS f ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES)- <br /> (X) 01 UNLEADED ( 1 02 REGULAR ( l 03 PREMIUM ( ) 04 DIESEL l ) 05 WASTE OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f ) GAUGE ( 1 INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED .(LOCATED IN AN UNDERGROUND VAULT) (X) 02 MON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL f 7 02 STAINLESS STEEL 1 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> f ) 06 ALUMINUM f 1 07 STEEL CLAD ( 1 08 BRONZE ( 1 09 COMPOSITE ( 1 10 NON-METALLIC <br /> f 7 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />