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STATE ID NUMBER00000065890001 <br /> APPLICATION FOR PERMIT TO OPERA UNDERGROUND STORAGE <br /> TANK <br /> 01 NEN PERMIT ( 1 05 RENEWED PERMIT ( 07 TANK CLOSED f 09 DELETE FROM FILE (NO FEE) <br /> 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT 1 ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAM!(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> SAN JOAQUIN COUNTY PbMt2B-1t8RN f 1 01 FED ( ) 02 STATE GCI -03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> • 222 2 STOCKTON CA 95z0Y�. <br /> II FACILITY <br /> FACILITY NAME /'/[/ DEALER/FOREMAN/SUPERVISOR <br /> mS6R�4W 2 1W (0,-k1l 6A tlORMAN J. DESMARAIS <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 444 S. WILSON WAY <br /> CITY COUNTY <br /> zxv <br /> STOCKTON SAN JOAQUIN 95205 <br /> MAILING ADDRESS CITYSTATE ZIP <br /> P.O. BOX 1810 STOCKTON CA 95201 <br /> PHONE W/AREA CODE TYPE OF BUSINESS p <br /> 209-944-3737 ( 1 01 GASOLINE STATION (X) 02 OTHER �4W6PASR mover POO <br /> NUMBER OF CONTAINERS RURAI ARIAS ONLY TOWNSHIP RANG! SECTION <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 /> NORCAN-d, DESMARAISj N. 209-944-3737 NIGHT WATCHMAN 209-944-2281 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUIBER,I4f'3 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: /0 GALLONS UNKNOWN E. DOES THE CONTAINER STORE: (X) 01 WASTE l 1 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? h6 1 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES)- <br /> ( ) <br /> 01 UNLEADED ( ) 02 REGULAR ( 1 03 PREMIUM ( ) 04 DI Sufi 05 WASTE OIL 1 106 OTHER <br /> V CONTAINER CONSTRUCTION / <br /> A. THICKNESS OF PRIMARY CONTAINMENT: l ) GAUGE ( ) INCHES J.1C1 CM UCY UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (Xf 02 NON-VAULTED 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED OCY 02 SINGLE WALLED ( ) 03 LINED <br /> D. ( ) 01 CARBON STEEL f 1 02 STAINLESS STEEL f ) 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( l 07 STEEL CLAD l 1 08 BRONZE ( 1 09 COMPOSITE 1 1 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( 1 13 OTHER: <br /> HSC04-070185 (08/29/86) PAGE 1 <br /> %W ✓ :' <br />