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• �� STATE IO NUMBER 00000000953002 <br /> APPLICATION FOR PERMIT TO UNDERGROUND STORAGE TANK <br /> l)Q <br /> 01 NEW PERMIT l ) 05 RENEWED PERMIT TANK CLOSED 00 09 DELETE FROM FILE (NO FEE) <br /> (T 02 CONDITIONAL PERMIT f 1 06 AMENDED PERMIT ( l� 8 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATICN.INDIVIOUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> ROEK CONSTRUCTION f 1 01 FED ( ) 02 STATE ( 03 LOCAL <br /> STREET 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 /> MAILING ADDRESS CITY STATE ZIP <br /> P. 0. BOX *"a 3 003 C& STOCKTON CA <br /> PHONE W/APEA 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 <br /> DAYS: NAMEfLAST NAME FIRST) AND PHONE W/AREA CODE! NIGHTS: NAMEILAST NAME FIRST) AND PHONE W/AREA CODE <br /> ROE J. I/.JLJOJJ 7_0 _ 6 3l` y U 1,20ek (/h I <br /> COMPLETE THE FOLLOWING ON ,A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK f 1 04 OTHER: CONTAINER NUMBER 2 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACI GALLONS (X) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WAST 01 YES ( ] 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> f 1 01 UNLEADED C ) 02 REGULAR ( ) 03 PREMIUM ) 04 DIESEL f ) 05 WASTE OIL ( ] 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 10 (X) GAUGE ( ) INCHES ( ) CM ( 7 UNKNOWN <br /> B. C 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. f 1 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( l 03 LINED <br /> D. ( l 01 CARBON STEEL ( 1 02 STAINLESS STEEL ( ) 03 FIBERGLASS t ) 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> (X1 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/851 PAGE 1 <br />