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� <br /> STATE ID NUMBER 00000010284007 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> f ) <br /> 01 NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> f 1 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPCFATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> NOR-CAL BEVERAGE CO., INC. ( ) 01 FED ( ) 02 STATE f ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 2286 STONE BLVD. WEST SACRAMENTO CA 95691 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> NOR-CAL BEVERAGE CO.. INC. BUTCH MUNSON <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1800 E. FREMONT ST. <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95205 <br /> MAILING ADDRESS CITYSTATE ZIP <br /> 1800 E. FREMONT ST. STOCKTON CA 95205 <br /> PHONE W/APEA CODE TYPE OF BUSINESS <br /> 209-943-0381 t ) 01 GASOLINE STATION (X) 02 OTHER SOFT DRINK DIST. <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 8 <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 /> BUTCH MUNSON 209-943-0381 BUTCH MUNSON 209-368-0714 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER R12 <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: 1977 C. YEAR INSTALLED 1977 ( 1 UNKNOWN <br /> D. CONTAINER CAPACITY: 2000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE ( ) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES (X) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> t ) 01 UNLEADED ( ) 02 REGULAR ( ] 03 PREMIUM ( ) 04 DIESEL ( l OS WASTE OIL ( l 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( 1 INCHES ( ) CM (X) UNKNOWN <br /> B. (X) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) f ) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( l 03 LINED <br /> D. t ) 01 CARBON STEEL t 1 02 STAINLESS STEEL ( ) 03 FIBERGLASS f l 04 POLYVINYL CHLORIDE f 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 1 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 />