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• • STATE ID NUMBER 00000006323001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> F� 0 EW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> VALLEY BEAN WAREHOUSE, INC. ( ) 01 FED ( ) 02 STATE 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> P.O. BOX 845, STOCKTON CA 95201 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> VALLEY BEAN WAREHOUSE, INC. TONY GONZALES, <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 200 N. ORO STREET ORO AVE. <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95205 <br /> MAILING ADDRESS CITY STATE SIP <br /> P.O. BOX 845 STOCKTON, CA 95201 <br /> PHONE W/AREA CODE- TYPE OF BUSINESS <br /> 209-464-9305 ( ) 01 GASOLINE STATION (X) 02 OTHER FORKLIFTS <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 1 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> GAYS: NA MEf LAST NAME FIRST) PH AREA��-EQ NIGHTS: .NAME(LAST NAME FIRST) AND PHONE W/AR!'A CODE <br /> ' �O <br /> F�wARD �M T�..f2 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): WESTERN METER SERVICE YEAR MFG: C. YEAR INSTALLED 1975 ( 1 UNKNOWN <br /> D. CONTAINER CAPACITY: 515 GALLONS ( l UNKNOWN TE. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES [ 1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( 1 INCHES f ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( l 03 LINED <br /> D. (16 01 CAREDN STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 AL=17Mf ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( 1 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />