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STATE ID NUMBER 00000016313001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> (7iO <br /> 01 NEW PERMIT f ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPOPATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> PACIFIC BELL ( ) 01 FED ( ) 02 STATE [ ) 03 LOCAL <br /> STREET ADDRESS fi � � dI CITY CA ZIP <br /> AA <br /> II FACILITY <br /> FACILITY NAME DEALER/FOPEMAN/SCUPERVISOR <br /> PACIFIC BELL (UE-694) C� <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1413 BOURBON STREET <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95204 <br /> MAILING ADDRESS CITY STATEZZP <br /> SdEL.iGANE?SCS" CA <br /> PHONE W/APEA CODE TYPE OF BUSINESS <br /> 415-"'" "P' ( ) 01 GASOLINE STATION (X) 02 OTHER PHONE CO. <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 /> EMERGENCY CONTROL CENTER 415 :8-4e:: 7 7 EMERGENCY CONTROL CENTER 415-542-ibBiga�f 7 7 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( l 04 OTHER: CONTAINER NUMBER 0-75-1K <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1975 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: 1 1 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) Ol YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( I <br /> 01 UNLEADED f 7 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL ( 1 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f ) GAUGE ( 1 INCHES ( ) CM (X) UNKNOWN <br /> B. f 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (XI 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. f ) 01 DOUBLE WALLED 4 02 SINGLE WALLED ( ) 03 LINED <br /> 0. (X) 01 CARBON STEEL f 1 02 STAINLESS STEEL f ) 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM f ) 07 STEEL CLAD f ) 08 BRONZE f ) 09 COMPOSITE ( 110 NON-METALLIC <br /> f ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />