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• • STATE ID NUMBER 00000011265002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 01 NEW PERMIT f l 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( 1 09 DELETE FROM FILE (NO FEE) <br /> ( 1 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( 1 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPOPATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> ( I 01 FED ( ] 02 STATE '1'03 LOCAL <br /> CITY OF STOCKTON <br /> STREET AODPESS CITY STATE ZIP <br /> 425 N. EL DORADO STOCKTON CA 95202 <br /> II FACILIT/Y � <br /> FACILITY NAME C�- DEALER/FOREMAN/SUPERVISOR <br /> COMPANY OFFICERS <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 110 W. SONORA COMMERCE <br /> CITU COUNTY IF <br /> STOCKTON SAN JOAQUIN 95203 <br /> MAILING ADDRESSCITY STATE ZIP <br /> 110 W. SONORA STOCKTON CA 95203 <br /> PHONE W/APEA CODE TYPE OF BUSINESS <br /> 209-944-8552 ( ) 01 GASOLINE STATION (X) 02 OTHER FIRE STATION <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> .JAS N/A N/A N/A <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAMEFIIRR T) AND PHONE W/AR A CODE <br /> gate- Dts Ke Y- coq-r»- %6d- 1/(r (� SAME al7T{ 111G Y J <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( 1 04 OTHER: CONTAINER NUMBER-W- <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: C. YEAR INSTALLED 1960 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 500 GALLONS f ) UNKNOWN E. DOES THE CONTAINER STORE: ( I Ol 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 /> ( 1 01 UNLEADED f ) 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL ( 1 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( 1 CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED (XI 03 UNKNOWN <br /> C. t ) 01 DOUBLE WALLED (�D2 SINGLE WALLED ( ) 03 LINED <br /> D. ( 1 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( l 03 FIBERGLASS ( 104 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> ( ] 06 ALUMINUM ( ] 07 STEEL CLAD ( 1 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> i • <br />