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��V' STATE ID NUMBER 00000034379001 <br /> APPLICATION FOR PERMIT TO 0 ATE` UNDERGROUND STORAGE TANK <br /> 1y0.1 NEW PERMIT ( 1 05 RENEWED PERMIT TANK CLOSED I ( ) 09 DELETE FROM FILE (NO FEE) <br /> - ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT 08 N }7C'E" (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPORATION,INDIVIOUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> A. A. 6 BOB ALLEN I( ) 01 FED f ] 02 STATE f ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 2904 BEYER LANE STCT Kl CA 95205 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> A. A. 6 BOB ALLEN BOB ALLEN <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 2904 BEYER LN WATERLOO RD <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95205 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 2904 BEYER LN STOCKTON CA 95205 <br /> PHONE W/ARCA CODE TYPE) OF BUSINESS <br /> 209-931-3535 ( 01 GASOLINE STATION (X) 02 OTHER TRUCKING YARD <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 1 <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 /> BOB ALLEN 209-wr' 4e5s %; I SAME - W;1P <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 0001 <br /> B. MANUFACTURER (IF APPROPRIATE): TANK WELDERS YEAR MFG: 1%5 C. YEAR INSTALLED 1965 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 8000 GALLONS 1 1 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 /> f ) <br /> 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( 1 05 WASTE OIL l ) 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. ( 1 01 DOUBLE WALLED (X) 02 SINGLE WALLED [ ) 03 LINED <br /> D. ( 1 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM M 07 STEEL CLAD ( ) OB BRONZE ( ) 09 COMPOSITE f ) 10 NON-METALLIC <br /> f ) 12 UNKNOWN ( ) 13 OTHER: <br /> KSC04-070185 (10/18/85) PAGE 1 <br />