Laserfiche WebLink
T � <br /> APPLICATION FOR PERMIT TO p*lam �C • STATE Ip <br /> 1 01 NEW PERMIT <br /> A T E NUMBER 00000037907003 <br /> ( ) 02 CONDITIONAL PERMIT UNDERGROUND <br /> ( 7 05 RENEWED PERMIT ND STORAGE TANK <br /> ( 7 06 AMENDED PERMIT ( 0 K CLOSED <br /> I <br /> OWNER f 7 08 MING AN <br /> GE f NO S <br /> ( ) 09 DELETE FROM FILE (NO FEE) <br /> SURCHARGE) <br /> NAME(COPPORATION.INDIVIDUALOR PUBLIC <br /> SEARS, ROEBUCK, AND COMPANY AGENCY) <br /> STREET ADDRESS PUBLIC AGENCY ONLY <br /> 5110 PACIFIC AVENUE ( ) O1 FED ( ) 02 STATE <br /> CITY f ) 03 LOCAL <br /> II FACILITY STOCKTON STATE ZIP <br /> CA 95207 <br /> (AGILITY NAME ' <br /> SEARS, ROEBUCK, AND COMPANY <br /> DEALER/FOREMAN/SUPERVISOR <br /> STREET .ADOPESS DICK 14HITAKER-DISTRIC 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 AVENUE CITY 95207 <br /> PHONE W/AREA CODE STOCKTON STATE ZIP <br /> 209-477-8111 TYPE OF BUSINESS DA 95207 <br /> f ) 01 GASOLINE STATION (X) 02 OTHER RETAIL STORE <br /> NUMBER OF CONTAINERS <br /> 10 RURAL AREAS ONLY TOWN Hip <br /> RANGE <br /> SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W' <br /> /AREA CODE <br /> DAVID BACON 209-477-8111 NIGHTS: NAME(LAST NAME FIRST) AND <br /> DAVID BACON PHONE W/gREA CODE <br /> 209-478-2644 <br /> COMPLETE THE FOLLONING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> a. rx, 0I rant; f J 04 OTHER: <br /> CONTAINER NUMBER 3 <br />. MANUFACTURER (IF APPROPRIATE): <br /> YEAR MFG: C. YEAR INSTALLED 1981 ( ) UNKNOWN <br /> CONTAINER CAPACITY: 10000 GALLONS f 1 UNKNOWN E. DOES THE CONTAINER STORE: ( 1 01 WASTE (X) 02 PRODUCT <br /> DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? <br /> (X) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL O( )E05 IJg5T020Io ( 7 06 OTHER <br /> IF YES CHECK APPROPRIATE BOX(ES): <br /> CONTAINER CONSTRUCTION <br /> THICKNESS OF PRIMARY CONTAINMENT: <br /> ( 1 GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br />( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NOH-VAULTED ( ) 03 UNKNOWN <br /> f ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> 1 O) 02 STAINLESS STEEL <br /> CARBON STEEL ( ) f ) ( ) ( ) <br /> ( 06 ALUMINUM (X) 07 STEEL CLAD ( ) pg BRO03 FIBERGLASS 04 POLYVINYL CHLORIDE <br /> NZE ( 1 09 COMPOSITE ( ) 10 NON-METALLIC <br /> 05 CONCRETE <br /> l 12 UNKNOWN ( ) 13 OTHER: <br />-070185 (10/18/851 <br /> PAGE 1 <br />