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elllevwvla" <br /> STATE ID NUMBER 00000043129003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> (,(I 01 NEW PERMIT ( ) 05 RENEWED PERMIT l��rI1) 07 TANK CIGSFD Cxl 09 DELETE FROM FILE (NO FEE) <br /> I <br /> ( 1 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT 1 00 KINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPOPATION.INOIVIOUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> TED I DENA KNOWLES ( ) 01 FED ( ) 02 STATE ( 1 03 LOCAL <br /> STREET ADDRESS CITYSTATE ZIP <br /> 1140 W. HAMMER LANE STOCKTON CA 95207 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> KNOWLES TED KNOWLES <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1140 W. HAMMER LANE THORNTON ROAD <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAgUIN 95207 <br /> MAILING ADDRESSCITY STATE ZIP <br /> 1140 W. HAMMER LANE STOCKTON CA 95207 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-951-9950 (X) 01 GASOLINE STATION f 1 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 6 <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 /> KNOWLES 209-951-9950 KNOWLES 209-477-3259 <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): MODESTO WELDING YEAR MFG: 1961 C. YEAR INSTALLED 1961 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 6000 GALLONS ( I UNKNOWN E. DOES THE CONTAINER STORE: ( 1 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 (X1 02 REGULAR ( 1 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 3/8 ( ) GAUGE (X1 INCHES ( ) CM ( ) UNKNOWN <br /> B. ( 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UWNOWN <br /> C. ! ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( l 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE f 1 05 CONCRETE <br /> ( ) 06 ALUMINUM f l 07 STEEL CLAD ( 1 08 BRONZE ( ) 09 COMPOSITE ( 1 10 NON-METALLIC <br /> t ) 12 UNKNOWN 1 ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> V ._.l <br />