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STATE ID NUMBER 00000042256002 <br /> APPLICATION FOR PERMIT TO �OPERATE UNDERGROUNjD STORAGE TANK <br /> ( 7 <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT IJ(1 07 TA EDI <br /> ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT f ) 06 AMENDED PERMIT (`�) NOR CHANG ( RCHARGE) <br /> I OWNER <br /> NAME(CORPCPATION.INDIVIDUAL OR PUBLIC AGENCY) -PUBLIC AGENCY ONLY <br /> JAMES R MILLER f 1 <br /> 01 FED ( ) 02 STATE f ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 2687 N. BEECHER RD ON 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 ZIP <br /> STOCKTON SAN JOAQUIN 95205 <br /> MAILING ADDRESS CITY STATF ZIP <br /> 2687 N BEECHER RD STOCKTON CA 95206 <br /> PHONE W/AREA COOK TYPE OF BUSINESS <br /> 209-931-0728 ( ) 01 GASOLINE STATION (X) 02 OTHER CEMENT CONTRACTOR <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> GAYS: N.4ME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> JAMES 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 2 <br /> B. MANUFACTURER (IF APPROPRIATE): STOCKTON MFG YEAR MFG: 1973 C. YEAR INSTALLED 1973 ( 1 UNKNOWN <br /> /TD <br /> D. CONTAINER CAPACITY: IJ&t GALLONS f l UNKNOWN E. DOES THE CONTAINER STORE: f ) 01 WASTE (X) 02 PRODUCT <br /> F. ODES 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 f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> 6 <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) 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 ( l 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ] 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( 1 06 ALUMINUM ( ) 07 STEEL CLAD ( 1 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ] 13 OTHER: <br /> MSC04-070185 (10/18/85) PAGE 1 <br /> 1i %we <br />