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' • STATE ID NUMBER 00000010265001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROU D STORAGE TANK <br /> ;;�"01 NEW PERMIT ( ) 05 RENEWED PERMIT l 07 TANK CLOSED .6� ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT CRANGE 140 SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,ZNDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> INTERSTATE TWXWP40WR rurZR jA-n CW q 1. J..Nc, f ] 01 FED ( ) 02 STATE ( l 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 825 NAVY DR STOCKTON CA 95206 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> INTERSTATE T.'.F)M( BEH*r!R 1MTERA/4-n OrU A 1. �..rrc. JOHN B PHILLIPS <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 825 NAVY D NAVY & STOCKTON <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95206 <br /> MAILING ADDRESS CITY STATE ZIP <br /> P.O. BOX 6463 STOCKTON CA 95206 <br /> PHONE W/APEA CODE TYPE OF BUSINESS <br /> 209-944-5821 ( ) 01 GASOLINE STATION (X) 02 OTHER TRUCK DEALERSHIP <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 1 <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 /> PHILLIPS> JOHN 209-944-5821 PMILLIPSr JOHN 209-462-8236 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. ( ) 01 TANK (X) 04 OTHER: SUMP CONTAINER NUMBER 9101 <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: 1971 C. YEAR INSTALLED 1971 f 1 UNKNOWN <br /> 0. CONTAINER CAPACITY: 53D GALLONS ( 1 UNKNOWN E. DOES THE CONTAINER STORE: (X) 01 WASTE f 1 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES f 1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL (X) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE f ) INCHES l ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( 1 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (n 02 SINGLE WALLED ( ) 03 LINED <br /> D. ( ) 01 CARBON STEEL ( 1 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( ] 05 CONCRETE <br /> ( 1 06 ALUMINUM ( 107 STEEL CLAD ( 1 08 BRONZE ( 1 09 COMPOSITE ( ) 10 NON-METALLIC <br /> fX) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> i � <br />