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��✓"" ��`$ STATE I0 NUMBER 00000001864003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) 01 NEW PERMIT ( ) 05 RENEWED PERMIT 07 07 TANK CLOSED 09 DELETE FROM FILE (NO FEE) <br /> f 1 02 CONDITIONAL PERMIT f 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARG <br /> I OWNER <br /> NAME(CORPOPATICN,INOIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> PAUL UMDENSTOCK f 1 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESSCITY STATE ZIP <br /> 711 E. MINER STOCKTON CA 95201 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> BIG VALLEY FORD PAUL UMDENSTOCK <br /> STREET DD ^ NEAREST CROSS STREEL <br /> 711 ER IV ififtM29Mtl7'" o)y-%� <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95201 <br /> MAILING ADDRESS CITY STATE ZIP <br /> P.O. BOX 1729 STOCKTON CA 95201 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-466-5211 ( l 01 GASOLINE STATION (X) 02 OTHER NEW CAR DEALER <br /> NUMBER OF CONTAINERS PUPAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 4 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> UMDENSTOCK, PAUL 209-466-5211 - - <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 3 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1965 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: (X) 01 WASTE ( ) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTEOIL ? ! 1 0 so ( 102 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> l 1 O1 UNLEADED f ) 02 REGULAR ( 1 03 PREMIUM ( ) 04 DIESEL 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( 1 CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( 1 03 LINED <br /> D. ( ) 01 CARBON STEEL f ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS f 1 04 POLYVINYL CHLORIDE ! 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE f 1 09 COMPOSITE l 1 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />