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ll� <br /> STATE ID NUMBER <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) O1 NEW PERMIT ( } 05 RENEWED PERMIT ( 1 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> i l 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT i ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CCRPOPATION,INCIVICUAL CR PU3LIC AGENCY) PUBLIC AGENCY ONLY <br /> CITY OF STOCKTON MUNICIPAL UTI ( ) 01 FED ( 1 02 STATE i ) 03 LOCAL <br /> STREET ACD;ESS CITY STATE ZIP <br /> 2500 NAVY DRIVE STOCKTON CA 95206 <br /> II FACILITY <br /> FACILITY NAME T"p%% v Z1 ANS DEALER/FOREMAN/SUPERVISOP <br /> A T r <br /> STFEET ADCPESS NEAREST CROSS STREET <br /> 2500 NAVY DRIVE F*E5 NWE r <br /> ITY COUNTY ZIP <br /> �STOCKTON SAN JOAQUIN 95206 <br /> MAILING ADDPESS CITY STATE ZiP <br /> 2500 NAVY DRIVE STOCKTON CA 95206 <br /> PY.O`:E '.'/A.PEA CODEQ TYPE OF BUSINESS <br /> 209- - 1-i� - ( 1 01 GASOLINE STATION (X) 02 OTHER WASTEWATER TREATMENT <br /> NUMBER OF CONTAINERS RURAL AREASONLY TOWNSHIP RANGE SECTION <br /> T` <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> pA}'S: NAME(LAST NAME FIRST) AND P�CNE SJ/AREA CODE NIGHTS: NAME(LAST N�Ef �PST) AND PHONE W:APEA CCCE <br /> OPERATOR IN CHARGE 20.9- 6- 'fry' (.�� '��� OPERATOR IN CHARGE09-4b6-� <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( 1 04 OTHER= CONTAINER, NUMBER-r- <br /> j 1� <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED lI ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: SC)b GALLONS f ) UNKNOWN EDOES THE CONTAINER STORE! IX) 01 WASTE i ) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WAVo <br /> OIL ? (x) 07YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM 04 DIESEL (-'-b5 WASTE OIL t ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT ( 1 GAUGE ( ) INCHES ( 1 CM (X) UNKNOWN <br /> B. i ) 01 VAULTED (LOCATED IN AN UF)DERGROUND VAULT) (X) 02 NON-VAULTED [ ) 03 UNKNOWN <br /> C. t l 01 DOUBLE WALLED (�d/02 SINGLE WALLED ( 1 03 LINED <br /> D. 01 CARBON STEEL ( 1 02 STAINLESS STEEL ( 1 03 FIBERGLASS t 1 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( l 08 BRONZE ( 1 09 COMPOSITE ( 1 10 NON-METALLIC <br /> —t 72 UNKNOWN ( ) 13 OTHER: <br /> r - <br /> HSC04-070185 (10/18/85) PAGE I <br />