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r <br /> 0 <br /> STATE ID NUMBER 00000010516001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 1 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( 1 07 TANK CLOSED ( ) 09 bELETF FROM FILE (NO FEE) <br /> ( 1 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( 1 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPOPATION,INDIVIOUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> WILLIAM JOSEPH ( ) 01 FED ( ) 02 STATE ( D 03 LOCAL <br /> STREET A.DDPESS CITY STATE ZIP <br /> 9799 FERNWOOD STOCKTON CA 95212 <br /> II FACILITY <br /> FACILITY NAME DEALER/FORESAN/SUPEPVISOR <br /> STOCKTON D*T6tO4. j E.J. WOODS <br /> STPEET .ADDP.ESS NEAREST CROSS STREET <br /> 2100 SANQUINETTI LANE STEWART ST. <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95205 <br /> MwILIN3 AODPESS CITY STATE ZIP <br /> P.O. BOX 8850 STOCKTON CA 95208 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 204-948-4027 ( ) O1 GASOLINE STATION (X) 02 OTHER DEALERSHIP <br /> NUMBER OF CONTAINS=S RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 2 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> E <br /> AME(LAST NAME FIRST) AND PHONE W/AREA COLE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> �c-5E 209-,948-9027 SAME <br /> AVS Lm <br /> PLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: — CONTAINER NUMBER I <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 GALLONS ( } UNKNOWN E. DOE5 THE CONTAINER STORE: [ ) 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 /> (X) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES [ ) CM (X) UNKNOWN <br /> B. [ } 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) _i411_02 NON-VAULTED (;J 03 UNKNOWN <br /> C. ( 9 01 DOUBLE WALLED f ) 02 SINGLE WALLED [ ) 03 LINED <br /> D. ( ) 01 CARBON STEEL i ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS [ 1 04 POLYVINYL CHLORIDE ( } 05 CCNCRETE <br /> [ ) 06 ALUMINUM { 1 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) <br /> PA <br />