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STATE ID NUMBER 00000001224001 <br /> APPLICATION FOR P€RMIT TO qWATE"UNDERGROUND STORAGE TANK <br /> 06 01 NEW PERMIT l ) 05 RENEWED PERMIT 07 TANK CLOS• ( ) 09 DELETE FROM FILE (NO FEE) <br /> I ) 02 CONDITIONAL PERMIT l ) 06 AMENDED PERMIT NGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPORATICN,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> D WUee A.$Set ;.4* ( ) 01 FED ( 1 02 STATE ( 1 03 LOCAL <br /> STREET ADDRESS CITYSTATE ZIP <br /> 308 N. GRANT STOCKTON CA 95202 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPER <br /> DE ROLLO MAZDA FJAUK-DF-P Iici/ <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 308 N GRANT MINER + ) <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 1 95202 <br /> MAILING ADDRESS - CITY STATE ZIP <br /> P.O. BOX 1370 STOCKTON CA 95202 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-942-2111 ( ) 01 GASOLINE STATION (X) 02 OTHER CAR DEALER <br /> NUMBER OF CONTAINERS PUPAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 1 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA COOS NIGHTS: NAME(LAST NAME FIRST) AND PRONE W/AREA CODE <br /> !l�IMlL�7f>Xr Nvow 219-9*e- m '�.' �/C�. # - <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 001 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> 0. CONTAINER CAPACITY: 1000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: f l 01 WASTE (X] 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( 1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> (X) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL l ) 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE f ) INCHES f ) CM (X) UNKNOWN <br /> B. f ] 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( ) 03 LINED <br /> D. ( 1 01 CARBON STEEL ( l 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( 1 08 BRONZE ( 1 09 COMPOSITE ( ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> ow ^"� <br />