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vir C <br /> �I�� • STATE ID NUMBER 00000008376003 <br /> R� bI I <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 1 NEW PERMIT ( 1 05 RENEWED PERMIT f 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 02 CONDITIONAL PERMIT f l 06 AMENDED PERMIT i 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> S T SERVICES ( ) 01 FED f ) 02 STATE ( ) 03 LOCAL <br /> STP.EET ADDRESS CITY STATE ZIP <br /> 17000 DALLAS PARKWAY SUITE 223 DALLAS TX 75248 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> S T SERVICES RICHARD ZIMMERMAN <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 2941 NAVY DR. WASHINGTON ST. <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95206 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 2941 NAVY DR. STOCKTON CA 95206 <br /> PHONE W/AREA CODE TYPEOF BUSINESS <br /> 209-943-5662 ( 1 01 GASOLINE STATION (X) 02 OTHER BULK STORAGE <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> 4 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> ZIMMERMAN, RICHARD 209-369-5051 SAME - - <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER #4 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 2000 GALLONS ( ] UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. QOYS THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ) 01 UNLEADED 401MINSENIAIMW ( ) 03 PREMIUM ( ) 04 DIESEL [ 1 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> 0 <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( 1 INCHES ( ) CM (X) UNKNOWN <br /> S. ( ) Of VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL (• ) 02 STAINLESS STEEL f 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 1 07 STEEL CLAD ( l 08 BRONZE ( ) 09 COMPOSITE 1 ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN f ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />