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APPLICATIONFOR PERMIT ud �7'� • STATE IO NUMBER <br /> ( ) 01 NEW PERMIT TO OPERATE UNDERGROUND STORAGE TANK 00000D379D7oo2 <br /> ' ( ) 02 CONDITIONAL PERMIT ( ) 05 RENEWED PERMIT <br /> ( ) 06 AMENDED PERMIT 07 TANK CLOSED <br /> IND ANGE (NO SURCHARGE)) 09 DELETE FROM FILE (NO FEEL <br /> I OWNER <br /> NA ME(COPPORATION.INDIVIDUAL OR PUBLIC <br /> SEARS, ROEBUCK, AND COMPANY AGENCY) <br /> STREET ADDRESS PUBLIC AGENCY ONLY <br /> 5110 PACIFIC AVENUE ( ) O1 FED ( ) 02 STATE ( ) 03 LOCAL <br /> CITY <br /> STOCKTON STATE ZIP <br /> II FACILITY CA 95207 <br /> FACILITY NAME <br /> SEARS, ROEBUCK, AND COMPANY <br /> STREET ADDRESS DICDEALER/FOREMAN/SUPERVISOR <br /> K WHITAKER-OISTRIC MGR. CIT <br /> 5110 PACIFIC AVENUE <br /> NEAREST CROSS STREET <br /> CITY YOKUTS <br /> STOCKTON <br /> COUNTY <br /> MAILING ADDRESS SAN JOAQUIN ZIP <br /> 5110 PACIFIC AVENUECITY 95207 <br /> PHONE W/AREA CODE STOCKTON STATE ZIP <br /> 209-477-8111 TYPEOF BUSINESS CA 95207 <br /> NUMBER OF CONTAINERS <br /> ( ) 01 GASOLINE STATION (X) 02 OTHER RETAIL STORE <br /> 10 RURAL AREAS ONLY : TOWNSHIP <br /> RANGE <br /> SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br />�DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> DAVID BACON 209-477-8111 NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> DAVID BACON 209-478-2644 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />[V DESCRIPTION C <br /> 0. (X) 01 TANK [ ) 04 OTHER: <br /> CONTAINER NUMBER 2 <br />�. MANUFACTURER (IF APPROPRIATE): <br /> YEAR MFG: C. YEAR INSTALLED 1964 ( ) UNKNOWN <br /> CONTAINER CAPACITY: 10000 GALLONS f ] UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> MOTOR <br /> DOES <br /> )S01 UNLEADED NER -----0REGULARVEHI;l0 E3FUUEL OR REMIUMWAS04 TE OILOIE(X) ( ) 05 WASTE OIL f ) 06 OTHER <br /> (EL 01 YES ( 7 02 NO IF YES CHECK APPROPRIATE BOX ES): <br /> CONTAINER CONSTRUCTION <br /> THICKNESS OF PRIMARY CONTAINMENT: <br /> f 1 GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> f ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) fX) 02 NON-VAULTED ( ) 03 UNKNOWN <br />( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br />( ) O1 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE f 1 05 CONCRETE <br /> ( ) 06 ALUMINUM (X) 07 STEEL CLAD f ) 08 BRONZE <br /> 12 UNKNOWN ( ) 13 OTHER: ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> f ) <br /> i-070185 (10/18/85) <br /> PAGE 1 <br />