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`/ STATE ID NUMBER 00000014149001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> O1 NEN PERMIT J5 RENEWED PERMIT f 1 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ! ) 02 CONDITIONAL PERMIT ( i 06 AMENDED PERMIT 1 ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIOUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CAPLIN-MCGIFF ENTERPRISES ( ) O1 FED f ) 02 STATE ( 1 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 1050 ELKHORN DR. STOCKTON CA 95209 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> ELKHORN COUNTRY CLUB 6NAR1W ", FGUNTAF1) <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1050 ELKHORN DRIVE DAVIS ROAD <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95209 <br /> MAILING ADDRESS CITYSTATE ZIP <br /> 1050 ELKHORN DRIVE STOCKTON CA 95209 <br /> PHONE W/APEA CO]'_ TYPEOF BUSINESS <br /> 209-477-8896 ( ) 01 GASOLINE STATION (X) 02 OTHER COUNTRY CLUB <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 1 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) ANO PHONE W/AREA CODE NIONTS: NAMC(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> �9' 209-477-6896 CAPLIN. TYLER 209-951-9444 <br /> 44 ESS <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( 1 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 GALLONS l ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F,43US THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES1: <br /> ) 01 UNLEADED -10 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL [ ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE f 1 INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) f ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( ) 03 LINED <br /> 0. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE f 1 05 CONCRETE <br /> ( ) 06 ALUMINUM f ) 07 STEEL CLAD f ) 08 BRONZE f 1 09 COMPOSITE ( l 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/851 PAGE 1 <br /> A•.r �' <br /> f <br />