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v <br /> STATE ZD NUMBER 00000064660004 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) <br /> 01 NEW PERMIT ( ) 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 /> y <br /> I OWNER <br /> NAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CAL TRANS I( ) 01 FED f ) 02 STATE ( 1 03 LOCAL <br /> ZIP <br /> STREET ADDRESS CITY STATE 9S20 <br /> 1976 E. CHARTER WAY STOCKTON CA 95205 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> STOCKTON-SHOP 10 JIM PEARSON <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1603 'S' B ST. CHRTE WY. <br /> CITY COUNTY IIP <br /> S70CKTON SAN JOAGUIN 95206 <br /> CITY STAT! ZIP <br /> MAILING ADDRESS CA 95206 <br /> 1603 'S' B ST. STOCKTON <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-948-7811 ( ) 01 GASOLINE STATION (X) 02 OTHER TRANSPORTATION <br /> NUMBER OF CONTAINERS RURAI AREAS ONLY TOWNSHIP RANGE SECTION <br /> 5 <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 /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 3070 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: GALL" (XI UNKNOWN E. DOES THE CONTAINER STORE: l ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (10 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE SOX(ES): <br /> l ) 01 UNLEADED ( ) 02 REGULAR t ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL (X) 06 OTHER UNKNOWN <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( 1 INCHES ( ] CM (X) UNKNOWN <br /> B. ( I 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) t ) 02 NON-VAULTED (XI 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( 102 SINGLE WALLED ( 1 03 LINED <br /> D. ( ) 01 CARBON STEEL I ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> l ) 06 ALUMINU7 f ) 07 STEEL CLAD f ) 08 BRONZE t ) 09 COMPOSITE ( ) 10 NOM-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (07/03/87) PAGE 1 <br />