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• • STATE IO NUMBER 00000011285003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> (Xf01 NEW PERMIT t 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( 1 09 DELETE FROM FILE (NO FEE) <br /> -T") <br /> ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COP.PORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CITY OF STOCKTON ( 1 01 FED ( ) 02 STATE (�03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 425 N. EL DORADO STOCKTON CA 95202 <br /> II FACILITY / //� yy�� <br /> FACILITY NAME e� p`� S C�Tv lIL'e. CD rrI- DEALER/FOREMAN/SUPERVISOR <br /> M -oe- COMPANY OFFICERS <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 110 W. SONORA COMMERCE <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95203 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 110 W. SONORA STOCKTON CA 95203 <br /> PHONE W/AF.EA CODE TYPEOF BUSINESS <br /> 209-944-8552 ( ) 01 GASOLINE STATION (X) 02 OTHER FIRE STATION <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> N/A N/A N/A <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: Nyyy°��MB(LAST�L1 44ME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> S*tTE' L/LS +ck a r- _ap?--K9' v� Yg SAME <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER-M <br /> S. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: C. YEAR INSTALLED 1960 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 GAL&CLEFU <br /> OWN E. DOES THE CONTAINER STORE: t ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEWASTE OIL ? (X) O1 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> 01 UNLEADED tX) 02 REGULAR ( ) 04 DIESEL ( ) 05 WASTE OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f I GAUGE ( I INCHES ( 1 CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED lXf 2 SINGLE WALLED ( ) 03 LINED <br /> D. ( ) 01 CARBON STEEL ( 1 02 STAINLESS STEEL f ) 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD f l 08 BRONZE ( 109 COMPOSITE ( 1 10 NON-METALLIC <br /> (XI 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />