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• STATE ID NUMBER 00000011283002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> L)J_01 NEW PERMIT f ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPOP.ATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CITY OF STOCKTON ( 1 01 FED ( ) 02 STATE PW 03 LOCAL <br /> STREET .ADDRESS CITY STATE ZIP <br /> 425 N. EL DORADO STOCKTON CA 95202 <br /> II FACILITY <br /> ( f�� <br /> FACILITY NAME F O S In'e LAi DEALER/FOREMAN/SUPERVISOR <br /> 'COMPANY OFFICERS <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 5525 PACIFIC AVE ROBINH00D <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95207 <br /> MAILING AOORESS CITY STATE ZIP <br /> 5525 PACIFIC AVE STOCKTON CA 95207 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-951-6113 ( ) 01 GASOLINE STATION (X) 02 OTHER FIRE STATION <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> 2 N/A N/A N/A <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> Dc ue: A�ASE(LAS Q�ME FIRS ANY PHONEi/A P.€A CODE NIGHTS: ji�ElLAST NA�M� F es) AC PHONE-'16 RCA CODE <br /> 7//LL <br /> COMPLETE THE FF/1OLLfOWWIC/NG ON A SEPARATE FORM P/'OCR//I EACHvC/ON/T�AC7IINEERvYd�/ <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER= CONTAINER NUMBER.W <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: C. YEAR INSTALLED 1967 f 1 UNKNOWN <br /> D. CONTAINER CAPACITY: 550 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: f ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES f ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> f 1 <br /> 01 UNLEADED ( 102 REGULAR (X) 03 PREMIUM ( ) 04 DIESEL f ) 05 WASTE OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: [ ) GAUGE ( 1 INCHES f 1 CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) f ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( l 01 DOUBLE WALLED (�2 SINGLE WALLED ( ) 03 LINED <br /> 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> f ) 06 ALUMINUM ( ) 07 STEEL CLAD ( l 08 BRONZE l ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> k <br /> 5 (10/18/85) PAGE 1 <br /> 0 <br />