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STATE ID NUMBER 00000031776001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 01 NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 1 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> SMITH HEATING AND AIR CONDITIO ( 1 01 FED f ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 1150 N. FILBERT STREET STOCKTON CA 95205 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> SMITH HEATING AND AIR CONDITIO <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1150 N. FILBERT STREET VINE <br /> CITY - COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95205 <br /> MAILING ADDRESS CITY STATE ZZP <br /> P.O. BOX 383 STOCKTON CA 95201 <br /> PHONE W/AREA COD! TYPE OF BUSS NESS <br /> 209-466-1434 ( 7 01 GASOLINE STATION IX) 02 OTHER CONTRACTING <br /> NUMSER 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 NIOMTS: NAM!(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> SMITH, KURT P. 209-466-1434 SMITH. KURT P. 209-466-1434 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER II <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1978 C. YEAR INSTALLED 1978 ( 1 UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 GALLONS ( l UNKNOWN E. DOES THE CONTAINER STORE: f ) 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 /> ( ) 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( 105 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS Of PRIMARY CONTAINMENT: 3/8 ( ) GAUGE (X) INCHES ( ) CM f 7 UNKNOWN <br /> S. I ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X1 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( 1 03 LINED <br /> D. (X) 01 CARBON STEEL 1 ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( l 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 1 07 STEEL CLAD ( 1 08 BRONZE ( 1 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN [ 1 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> ti/ 1f <br />