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STATE ID NUMBER &04046+W R9 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> C 1 01 NEW PERMIT ( l 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> E ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT l 1 08 MINOR CHANGE (No SURCHARGE) <br /> I OWNER <br /> NAME(COPPOPATION.INDIVIDU.AL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CITY OF STOCKTON - MUNICIPAL U t 1 01 FED ( 1 02 STATE 03 LOCAL <br /> ( ) <br /> STPEE7 ADDRESS CITY STATE ZIP <br /> 2500 NAVY DRIVE STOCKTON CA 95206 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> Y <br /> MAN V�_FRAT , SUPERVISOR <br /> STREET .ADMPESS 1 NEAREST CROSS STREET <br /> 2500 NAVY DRIVE TILLIE LEWIS DRIVE <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOA4UIN 95206 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 2500 NAVY DRIVE STOCKTON CA 95206 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209_ ( l 01 GA50LINE STATION (X) 02 OTHER WASTEWATER TREATMENT <br /> N'UMSEP. OF CQNTAINEP.S RURAL APE AS ONLY TOWNSHIP RANGE SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> FOOP�ERATOR <br /> N EfLAST NAME FIRST) AND PHONE W/AREA CODE 77]NIGHTS: N.AME( LAST NAME FIRST) AND PHONE W AREA CODE <br /> IN CHARGE 209-466-5 { ��5 OPERATOR IN CHARGE 209-466-5e6-1 $ pb <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK t ) 04 OTHER: CONTAINER NUMBER UG I <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1978 i ) UNKNOWN <br /> Boo <br /> D. CONTAINER CAPACITY: --159 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE- (X) 01 WASTE i ) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( l 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( l 01 UNLEADED t ) 02 REGULAR i l 03 PREMIUM ( ) 04 DIESEL (X) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 20 (X1 GAUGE ( l INCHES ( ) CM ( 1 UNKNOWN <br /> B. ( l 01 VAULTED (LOCATED IN AN UNDERGROUND VAULTL W NON-VAULTED ( 1 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> i <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL { ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> ( 1 06 ALUMINUM t ) 07 STEEL CLAD ( ) 08 BRONZE ( 1 09 COMPOSITE ( 110 NON-METALLIC <br /> [ ) 12 UNKNOWN ( ) 13 OTHER. <br /> HSC04-070185 (10/'18/85) PAGE I <br />