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STATE ID NUMBER 00000068174001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ql ( ) 09 DELETE FROM FILE (NO FEE) <br />� ) Ol NEW PERMIT ( ) 05 RENEWED I 7 TANK CHANGE�(NO SURCHARGE) <br />( � 02 CONDITIONAL PERMIT f ) 06 AMENDED PERMIT ) 08 <br /> OWNER PUBLIC AGENCY ONLY <br /> ME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) <br /> l l O1 FED ( ) 02 STATE.. I--] 03 LOCAL <br />,LIF DEPT OF TRANSPORTATION STATE ZIP <br /> CITY CA 95814 <br />'BEET ADDRESS SACRAMENTO <br /> l20 N STREET <br /> I FACILITY <br /> DEALER/FOREMAN/SUPERVISOR <br /> ACILITY NAME <br /> TOCKTON <br /> NEAREST CROSS STREET <br /> TREET ADDRESS <br />.12 S LINCOLN STREET IIP <br /> COUNTY 95202 <br />:ITY SAN JOAQUIN <br /> STATE ZIP <br /> CITY CA 95202 <br /> 7pIlINC ADDRESS <br /> S12 S LINCOLN STREET <br /> TYPE OF BUSINESS <br />'HONE W/AREA CODE ( ) O1 GASOLINE STATION l ) 02 OTHER <br /> 209-948-7109 RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> NUMBER OF CONTAINERS <br /> 1 <br /> III 24 HOUR EMERGENCY CONTACT PERSON NIGHTS: NA lLA T NA E FIRST) AND PHONE W/AREA CODE <br /> /� 3 - <br /> DAYS: NAME AST NAME IRS . AND PHONE i -/A � ��/O <br /> I <br /> EACH CONTAINER <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR <br /> IV DESCRIPTION _ <br /> CONTAINER NUMBER 0000000001 <br /> A. (X) O1 TANK ( ) 04 OTHER: <br /> YEAR MFG: C. YEAR INSTALLED 1982 ( ) U(ACNOWN <br /> B. MANUFACTURER (IF APPROPRIATE): <br /> D. CONTAINER CAPACITY: 2000 GALLONS ( 1 UNKNOWN E. DOES THE CONTAINER STORE: ( ) O1 WASTE (X) 02 PRODUCT <br /> NK <br /> NO <br /> F. DOESo2 <br /> CONTAINER ST0REMOTCREGULARVE(I)L03F PREMIUM (T) 04LDIESEL O( )E 05 WASTE2OIILL (1l 06YES <br /> OTHER CHECK <br /> APPROPRIATE BOXES I: <br /> 1. UNLEADED ( <br /> pINER CONSTRUCTION <br /> OF PRIMARY CONTAINMENT: <br /> ( 1 GAUGE ( ) INCHES ( ) CM l ] UNKNOWN <br /> B. ULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. UBLE WALLED ( ] 02 SINGLE WALLED 1 03 LINED <br /> D. R AOLUMINUMN SL (( 1)0025 STAINLESS <br /> STEEL <br /> 08(BRONZEFIBERGL09SC POSITE 04 POL)V10YNON-METALLICIDE ( ) 05 CONCRETE <br /> EEL CLAD <br /> KNOWN ( ) 13 OTHER: PAGE 1 <br /> HSC04-070185 (07/03/87) <br />