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• • STATE ID NUMBER 00000011285004 <br /> _*0 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( 01 NEW PERMIT ( 1 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 /> N>ME(COPPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CITY OF STOCKTON ( ] 01 FED ( ] 02 STATE (}S4-03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 425 N. EL DORADO STOCKTON CA 95202 <br /> II FACILITY / ' <br /> FACILITY NAME �Y,. p S`}0 L�T(/nf-V1=�, DEALER/FOREMAN/SUPERVISOR <br /> • 7 2— COMPANY OFFICERS <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 110 W. SONORA COMMERCE <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JDAQUIN 95203 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 110 W. SONORA STOCKTON CA 95203 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-944-8552 ( 1 01 GASOLINE STATION (X) 02 OTHER FIRE STATION <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> XS N/A N/A N/A <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NA E(LAST NAME FIRST) cAND PHONE W�//AREA CODE NIGHTS: NAME(LAST NAME FIRST) ANtDL PHONE W/AREA CODE <br /> LA_s �/ yH /S SAME mfg SYI- �bS/8 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( l 04 OTHER: CONTAINER NUMBER,20 <br /> B. MANUFACTURER IIF APPROPRIATE): UNKNOWN YEAR MFG: C. YEAR INSTALLED 1960 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 500 GALLONS f ) UNKNOWN E. DOES THE CONTAINER STORE: (X) 01 WASTE ( ) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( l 02 NO IF YES CHECK APPROPRIATE SOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL (X) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( 1 INCHES ( ) CM (X1 UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ,02 SINGLE WALLED ( 1 03 LINED <br /> D. ( ) 01 CARBON STEEL ( l 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( l 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( 1 08 BRONZE ( ) 09 COMPOSITE ( 1 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />