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STATE IB NUMBER 00000006886002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) O1 NEW RERMIT ( 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED i 1 09 DELETE FROM FILE (NO FEE) <br /> i 1 b2 CONBITIONAL PERMIT f ) 06 AMENDED PERMIT [ 1 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> [ 1 <br /> 01 FED f ) 02 STATE ( ) 03 LOCAL <br /> PACIFIC BELL <br /> jjITY _ ST_ <br /> ATE ZIPSTREET ADDRESS <br /> 370 THIRD STREET AN FRANCISCO CA 94107 <br /> II FACILITY <br /> FACILITY N&ME DEALER/FOREMAN,'SJPEPVISOP <br /> PACIFIC BELL (UE-R47) E. J. KOEHLER <br /> STREET AODPESS NEAREST CROSS STREET <br /> 4051 NEWTON ROAD <br /> COUNTY ZIP <br /> CITY 95205 <br /> STOCKTON SAN JOAQUIN <br /> MAILING ADDRESS CIT STATE IIP <br /> 370 THIRD STREET, ROOM 690G SAN FRANCISCO CA 94107 <br /> PHONE W/APE.A CODE TTYPE OF 'BUSINESS <br /> 415-542-6758 ) 01 GASOLINE STATION (X) 02 OTHER PHONE CO. <br /> NU!^BEP OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> GAYS: NAME(LAST NAME FIP.ST) AND PHONE W/AREA CODE NIGHTS: NAME(L.AST N?ME FIRST) AND PHONE W/ARE.A CODE <br /> EMEF.GENCY CONTROL CENTER 415-542-4601 EMERGENCY CONRTOL CENTER 415-542-4601 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION .. - <br /> 1 <br /> A. (X) 01 TANK ( ) 04 OTHER CONTAINER NUMBER G-XX-8K <br /> B. MANUFACTURER (IF APPP.OPP,IATE) YEAR MFG C. YEAR INSTALLED. (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 8000 GALLONS f ) UNKNOWN E. DOES THE CONTAINER STORE' ( 1 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 /> [ } O1 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM C } 04 DIESEL ( 1 05 WASTE OIL [ ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( } GAUGE ( ] INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NDN-VAULTED t ) 03 UNKNOWN <br /> C. [ 1 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. { } 01 CARBON STEEL ( ) 02 STAINLESS STEEL i ) 03 FIBERGLASS ( } 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( 1 06 ALUMINUM ( ) 07 STEEL CLAD ( 1 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN { l 13 OTHER: <br /> PAGE 1 <br /> HSC04-070185 (10/18/85) <br />