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APPLICATION FOR <br /> If 02 ONDIER T PERMIT PERMIT <br /> TO OPERATE UND STATE ID NUMBER 00000037907004 <br /> ( ) 06 AMENDED PERCIIT (� ERGROUND RAGE T <br /> I STO ANK <br /> OWNER ( ) 08 MINOR CHANGE <br /> (NO SURCHARGE) ) 09 DELETE F <br /> NAME(CORPORATION, FROM FILE (NO <br /> SEARS, ROEBUCK INDIVIDUAL OR FEF) <br /> > AND COMPANY Pus LIC AOE NCYJ <br /> STREET ADDRESS <br /> 5110 PACIFIC AVENUE PUBLIC <br /> AGENCY ONLY <br /> ( ) <br /> FACILITY Dlir O1 FED ( ) 02 STATE <br /> II <br /> ( ) D3 LOCAL <br /> FACILITY NAME STOCKTON STATE CA ZIP <br /> 95207 <br /> SEARS, ROEBUCK, AND COMPANY <br /> STREET aDDREss <br /> : DICK DEALER/FOREMAN/SUPERVISOR <br /> 5110 PACIFIC AVENUE ►WITAKER-OISTRIC MGR. CIT <br /> CITY <br /> NEAREST CROSS STREET <br /> STOCKTON YOKUTS <br /> COUNTY <br /> MAILING ADDRESS SAN UOAQUIN <br /> 5110 PACIFIC AVENUEZIP <br /> CITY 95207 <br /> PHONE W/AREA CODE STOCKTON <br /> TYPE OF BU STATE ZIP <br /> 209-477-8111 Si NESS CA <br />' ( ) )I GASOLINE STAT <br /> NUMBER OOF CONTAINERS RURAL 401AS ONLY : TOWNSHIP ON (X) 02 95207 <br /> OTHER RETAIL STORE <br /> Rq NGE <br /> SECTION <br /> III 24 HOUR EMERGENCY CONTICT PERSON <br /> DAYS: NAME(LAST %'Y! FIRST) AIC PHONE E4 CCOE <br /> DAVID BACON 209-677-8111 NIGHTS: Nbill! ST NAME FIRST) ANO PHONE <br /> DAVID BACON <br /> 2644 W/AREA CODE <br /> 209-478- <br /> COMPLETE THE FOLLONG ON A SEPARATE FORM FOR <br /> IV DESCRIPTION EACH CONTAINER <br /> A. (X) 01 TANK ( 1 04 OTHER: <br /> CONTAINER NUMBER 4 <br /> B. MANUFACTURER (IF APPROPRIATE): <br /> YEAR MFG: C. YEAR INSTALLED <br /> D. CONTAINER CAPACITY: 2000 GALL )11 UNKNOWN E. DOES THE CONTAINER STORE: 1964 ( ) UNKNOWN <br /> F. DOES THE CONTAINER STORE MOTOR VEH I'EL OR WASTE OIL ? ( ) 01 WASTE (X) 02 PRODUCT <br /> L ) 01 UNLEADED ( ) 02 REGULAR ( REMIUM (X) 04 DIESEL 01 YES ( ) 02 NO IF( 1 OYESb OTCHHERECK <br /> ( ) OS WASTE OIL APPROPRIATE BOX(ES): <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE <br /> ( ) INCHES ( ) CM [X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERJAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) O1 DOUBLE WALLED (X) 02 SINGLE ( ) 03 LINED <br /> p. ( ) 01 CARBON STEEL ( ) 02 STAINLE ( ) 03 FIBERGLASS <br /> ( ) 06 ALUMINUM (X) 07 STEEL CLS BRONZE ( ) 04 POLYVINYL CHLORIDE <br /> ( ) 12 UNKNOWN ( 1 13 OTHER: ( 1 09 COMPOSITE ( ) 10 <br /> No <br /> 1 05 CONCRETE <br /> HSC04-070185 (10/18/85) <br /> PAGE 1 <br /> 0 <br />