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e�c�ooc�3ts3°►� <br /> STATE ID NUMBER 1 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> f ) O1 NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( l 09 DELETE FROM FILE (NO FEE) <br /> i 1 02 CONDITIONAL PERMYT ( ) 46 AMENDED REKNIT l 1 fl8 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NA"!fCORFOPATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CITY OF STOCKTON - MUNICIPAL U ( 1 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITI" STATE JZIP2500 NAVY DRIVE 5TOCKTON CA 5246 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOPEMAN/SUPERVISOR <br /> MAIN PLANT , SUPERVISOR kit S�i' U <br /> STREET ADDPESS NEAREST CROSS STREET <br /> 2500 NAVY DRIVE TILLIE LEWIS DRIVE <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95206 <br /> MAILING ADDPESSCITY =CA <br /> TE ZIP <br /> 2500 NAVY DRIVE STOCKTON 95206 <br /> PHONE W/ARE,4 CODE p TYPE OF 9USINESS <br /> 01 GASOLINE STATION (X) 02 OTHER WASTEWATER TREATMENT <br /> NUMBER CFr�CONTAINERS PUPAL AREAS ONLY TQWNSHIR ;ANGE SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> F <br /> NAME(LAST ti .E FIRST) .4ND PHtlNE W.'ARE.4 CQDE NIGHTS: NAt1E(L.4ST NAME FI*ST) .4N0 RHONE WIAREA CODE <br /> TOR IN CHARGE 209-4 '9 q 1; �� OPERATOR IN CHARGE 209-irbd=*�'L61yl;�� � <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER CONTAINER NUMBER ME 291 , <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1975 l 1 UNKNOWN <br /> 0. CONTAINER CAPACITY= 5000 GALLONS t 1 UNKNOWN £. DOES THE CONTAINER STORE: [ ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> E ) 41 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( 9 04 DIESEL E 1 05 WASTE OIL ( } 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: .25 ( ) GAUGE EX) INCHES ( ) CM (, J UNKNOWN <br /> B. ( J 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( J 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 1 07 STEEL CLAD ( ) 08 BRONZE t 1 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> 0 <br />