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J • • STATE ID NUMBER 00000037907007 <br /> APPLICATION FOR PERMIT TO OPENDERGROUND STORAGE TANK <br /> O1 NEW PERMIT 05 RENEWED PERMIT *1,4J' 07 ..rw r)rtsD ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) f l <br /> ( 1 02 CONDITIONAL PERMIT ( l 06 AMENDED PERMIT ( ] 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COFPORATION,IND IVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> SEARS, ROEBUCK, AND COMPANY ( ) 01 FED ( ) 02 STATE ( 7 03 LOCAL <br /> CITY STATE ZIP <br /> STREET ADDRESS STOCKTON CA 95207 <br /> 5110 PACIFIC AVENUE <br /> II FACILITY <br /> FACILITY NAME DEALER/FOPEMAN/SUPERVISOR <br /> SEARS, ROEBUCK, AND COMPANY DICK WHITAKER-OISTRIC MGR. CIT <br /> STREET ADOPESS NEAREST CROSS STREET <br /> 5110 PACIFIC AVENUE YOKUTS <br /> COUNTY ZIP <br /> STOCKTON <br /> CITY STATE ZIP <br /> CITY SAN JOAQUIN 95207 <br /> MAILING ADDRESS <br /> 5110 PACIFIC AVENUE STOCKTON CA 95207 <br /> PHONE W/APEA CODE TYPE OF BUSINESS <br /> 209-477-8111 ( ) 01 GASOLINE STATION (X) 02 OTHER RETAIL STORE <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> 10 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) <br /> AND <br /> 8-2644PHONE <br /> W/AREA CODE <br /> DAVID BACON 209-477-8111 DAVID BACON <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK f 1 04 OTHER: CONTAINER NUMBER 7 <br /> D. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1964 f ) UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: t ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL ( l 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE f ] INCHES ( ) CM (X) UNKNOWN <br /> e. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. ( 1 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( l 05 CONCRETE <br /> ( ) 06 ALUMINUM (X) 07 STEEL CLAD l l 08 BRONZE ( 1 09 COMPOSITE ( 1 10 NON-METALLIC <br /> ( 1 12 UNKNOWN f ) 13 OTHER: <br /> PAGE 1 <br /> HSC04-070185 (10/18/85) <br />