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STATE I0 NUMBER 00000064660004 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> (7(1 <br /> 01 NEW PERMIT t l 05 RENEWED PERMIT 1117TA LOSED 2 fb ti ( ) 09 DELETE FROM FILE (NO FEE) <br /> •r j 02 CONDITIONAL PERMIT t ) 06 AMENDED PERMIT 1 08 MINOR CHA T (N0 SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CAL TRANS ( ) 01 FED ( 1 02 STATE f 1 03 LOCAL <br /> STREET ADDRESS CITY STATE <br /> 1976 E. CHARTER WAY STOCKTON CA <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> STOCKTON-SHOP 10 - JIM PEARSON <br /> ;TREET ADDRESS NEAREST CROSS STREET <br /> 1603 'S' B ST. CHRTE WY. <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95206 <br /> MAILING ADDRESS CITY STATE IIP <br /> 1603 'S' B ST. STOCKTON CA 9S2(191/ <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-948-7811 I 1 01 GASOLINE STATION (X) 02 OTHER TRANSPORTATION <br /> NUMB?R OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 5 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NA (LAST NAME FIRST) AND/PHONE W/APEA CODE NIGHTS: N/EAM!E(LAST NAME FIRST) AND PHONE W/ARCA CODE <br /> -YTDwl <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 307C <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLEDQ' (X) +4EENI <br /> D. CONTAINER CAPACITY: 3 GALLONS "I UNKNOWN E. DOES THE CONTAINER STORE. ( ) 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 ( ) 02 REGULAR ( ) 03 PREMIUM ( 1 04 DIESEL ( ) 05 WASTE OIL (X) 06 OTHER UNKNOWN <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( 1 INCHES ( 1 CM (X) UNKNOWN <br /> B. t ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED t.Wr 03 UNKNOWN <br /> C. I 1 01 DOUBLE WALLED I 1 02 SINGLE WALLED ( ) 03 LINED <br /> 0. ICl O1 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS l ) 04 POLYVINYL CHLORIDE I 1 05 CONCRETE <br /> I 1 06 ALUMINUM I 1 07 STEEL CLAD f 1 08 BRONZE ( ) 09 COMPOSITE f 1 10 NDN-METALLIC <br /> (.H' 12 UNKNOWN ( 1 13 OTHER: <br /> NSC04-070185 (10/18/85) PAGE 1 <br /> NOW lmd <br />