Laserfiche WebLink
1 <br /> STATE IO NUMBER 00940463809001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK ll <br /> 0 NEW P ZONA ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 (DELETE FROM FILE (NO FEE) <br /> c L PERMIT C ) 06 AMENDED PERMIT ( 1 O8 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER j ��y� <br /> NAME(CCRPORATION,INDIVIDUAL OR PUBLIC AGENCY) Ef�'�� "� �' � PUBLIC AGENCY ONLY <br /> 01 FED ( ) 02 STATE ( I 03 LOCAL <br /> � (' G do-07,x& ,�C e. 5A H' CITY �T���ISYi STATE CA ZIP � (� <br /> STFEET <br /> ADDRESS [. <br /> "4Wjz2r 5544r"--m <br /> s�-a-r�•Ica�-wat-t <br /> II FACILITY <br /> FACILITY NAME ♦ y'� DEALER/FOREMAN/SUPERVISOR <br /> STREHT ADDRESS NEAREST CROSS STREET <br /> Oa50 EAST LOOMIS AVENUE <br /> Y COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 99t" <br /> MAILING ADDRESS CITY STATE ZIP <br /> 43511 EAST LOOMIS AVENUE STOCKTON CA <br /> PHON1 W/APEA CCDE TYPE_oo <br /> F BUSINESS <br /> ;4$35 (.-70 f-l�'dLo ( 1 GASOLINE STATION (X) 02 OTHER TRUCK TERMINAL <br /> NUMSEP OF CONTAINERS RURpL AREAS ONLY TOWNSHIP RANGE SECTION <br /> III 24 DOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA C6 <br /> C-6A*KT-;W t <br /> 7a g 0 v iuJZ- <br /> COMPLETE THE FOLLOWING ON A SEPARATE SRM FOR EACH CONTAINER <br /> I DESCRIPTION <br /> A. (X) 01 TANK f ) 04 OTHER: CONTAINER NUMBER #1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X1 UNKNOWN <br /> D. CONTAINER CAPACITY: 12000 GALLONS E ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE EX) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? tX) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED Oh 02 REGULAR ( ) 03 PREMIUM (k) 04 DIESEL ( ) 05 WASTE OIL t ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: [ 1 GAUGE ( ) INCHES f ) CM (X) UNKNOWN <br /> B. t } 01 VAULTED (LOCATED A AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( 3 03 LINED <br /> 0. ( ) 01 CARBON STEEL ( 1 02 STAINLESS STEEL ( ) 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE ( 105 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE t ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) )/ PI�'r'%s��rT r'�.( PAGE 1 <br /> �� f Ci <br />