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STATE ID NUMBER 00000037907001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> f 1 <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT ,�.� <br /> ( ) 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT (T) 08 <br /> '.A' <br /> RrCHANGE (NO SURCHARGE( ) <br /> —moi ( ) 09 DELETE FROM FILE (NO FEE) �.. <br /> I OWNER <br /> E. E <br /> INDIVIDUALElORPUBLIC AGENCY) <br /> ND COMPANY PUBLIC AGENCY ONLY <br /> ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> E carr STATE ZIP <br /> STOCKTON CA 95207 <br /> II FACILITY <br /> FACILITY NAME <br /> SEARS, ROEBUCK, AND COMPANY DEALER/FOREMAN/SUPERVISOR <br /> DICK WHITAKER-DISTRIC MGR. CIT <br /> STREET ADDRESS <br /> 5110 PACIFIC AVENUE NEAREST CROSS STREET <br /> YOKUTS <br /> CITY <br /> STOCKTON COUNTY ZIP <br /> SAN JOAQUIN 95207 <br /> MAILING ADDRESS <br /> 5110 PACIFIC AVENUE CITY STATE ZIP <br /> STOCKTON <br /> PHONE W/AREA CODE <br /> 209-477-8111 TYPE OF BUSINESS CA 95207 <br /> ( ) 01 GASOLINE STATION (X) 02 OTHER RETAIL STORE <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY <br /> 10 TOWNSHIP RANGE <br /> SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAM--(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND <br /> DAVID BACON 209-477-8111 PHONE W/AREA CODE <br /> DAVID BACON 209-478-2644 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: <br /> CONTAINER NUMBER 1 <br /> S. MANUFACTURER (IF APPROPRIATE): <br /> YEAR MFG: C. YEAR INSTALLED 1964 f ) UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X1 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? <br /> ( ) 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( 1 04 DIESEL 0( )EOb WASTE20IOL (I) 06 SOTHERK APPROPRIATE BOX(ES): <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f l GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED fX) 02 SINGLE WALLED ( ) 03 LINED <br /> 0. ( l 01 CARBON STEEL ( 1 02 STAINLESS STEEL f ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM (X) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( 1 12 UNKNOWN f ) 13 OTHER: <br />(SC04-070185 (10/18/85) <br /> PAGE 1 <br />