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II � STATE ID NUMBER 00000000953001 <br /> / 6 <br /> r APPLICATION FOR PERMIT T 0 AITE UNDERGROUND STORAGE TANK <br /> I AO1 NEW PERMIT t 1 05 RENEWED PERMI TANK CLOSED 0<f 09 DELETE FROM FILE (NO FEE) <br /> 42 CONDITIONAL PERMIT f 1 06 AMENDED PERMI 0 <br /> 8 MINOR CHANGE (NO SURCHARGEI <br /> I OWNER <br /> NAHE(CORPOPATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> ROEK CONSTRUCTION ( ) 01 FED l ) 02 STATE ;.003 LOCAL <br /> ST P.EET ADDRESS CITY STATE ZIP <br /> 3736 SOUTH HIGHWAY 99 STOCKTON CA 95205 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> ROEK CONSTRUCTION <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 3736 S. HIGHWAY 99 <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95205 <br /> CITY - STATE ZIP <br /> MAILING ADDRESS STOCKTON CA Q Ti ZI 3 <br /> P. 0. Box-iiw <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-464-8344 ( ) 01 GASOLINE STATION (X) 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> 2 <br /> III 24 HOUR EMERGENCY CONTACT PERSON 9y <br /> DAYS: NAME NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NA�.ME(LAST NAME FIRST) ANo PHO=E <br /> ROEK. d: /. 'JTEdd• 8 3 U /�cjp� 1 �!/V/ y/ VyJJ <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF A OPRIATEI: YEAR MFG: C. YEAR INSTALLED (X1 UNKNOWN <br /> 0. CONTAINER CAP CITY: Q U LLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONT INER STORE MOT VEHICLE FUEL OR WASTE OIL ? (X) 01 YES f 1 02 NO IF YES CHECK APPROPRIATE SOX(ES): <br /> ( 1 O1 UNLEADE f R ( 1 03 PREMIUM f ) 04 DIESEL ( 1 05 WASTE OIL ( i 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 10 (X) GAUGE ( ) INCHES ( ) CM ( ) UNKNOWN <br /> B. f 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( 1 03 LINED <br /> D.�O1 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( l 05 CONCRETE <br /> 06 ALUMINUM ( 1 07 STEEL CLAD ( ) 08 BRONZE ( 1 09 COMPOSITE ( 1 10 NON-METALLIC <br /> AF ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE ]. <br /> f <br />