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STATE ID NUMBER 00000042256001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUN STORAGE TANK <br /> ( l <br /> 01 NEW PERMIT ( 1 05 RENEWED PERMIT Ob 07 TANK CLOSED '9 fP ( ) 09 DELETE FROM FILE (NO FEE) <br /> t ) 02 CONDITIONAL PERMIT f ) 06 AMENDED PERMIT ( ) -OT71TOWICTFINGE ( 0 SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATICN,INDIVIOUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> JAMES R MILLER f ) O1 FED ( 7 02 STATE ( l 03 LOCAL <br /> STREET ADDRESS CITY STATE IIP <br /> 2687 N. BEECHER RD STOCKTON CA 95205 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> JAMES R MILLER CONCRETE <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 2687 N BEECHER RD HWY 26 <br /> CITY COUNTY <br /> ZZP <br /> STOCKTON SAN JOAgUIN 95205 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 2687 N BEECHER RD STOCKTON CA 95205 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-931-0728 ( ) 01 GASOLINE STATION (X) 02 OTHER CEMENT CONTRACTOR <br /> NUMBER OF CONTAINERS , RURAL AREAS ONLY TOWNSHIPRANGE SECTION <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> OATS: NAME(IAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> JAHES MILLER 209-931-0728 SAME - <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): STOCKTON MFG YEAR MFG: 1968 C. YEAR INSTALLED 1968 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 550 GALLONS ( ) 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 /> (X) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE f 1 INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED f 1 03 LINED <br /> 0. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( ] 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 107 STEEL CLAD f ) 08 BRONZE ( ) 09 COMPOSITE 1 ) 10 NON-METALLIC <br /> ( 1 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />