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STATE ID NUMBER 00000021890002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> O1 NLw PERMIT C ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> (/ )-02 CCNDITIaNAL PERMIT [ 1 06 AMENDED PERMIT I 1 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAMEtCCPPORATION.I':DIVIDUAL OR PU3LIC AGENCY) FPUBLIC AGENCY ONLY <br /> 01 FED ( ) 02 STATE ( ] 03 LOCAL <br /> .JOHN PHILLIPS <br /> =5TOCKTON <br /> STATE ZIP <br /> STPEE7 ADDRESS CA 95206 <br /> P.O. BOX 6463 <br /> II FACILITY <br /> FACIL'T'e NAMECom ] ) DEALERiFOREMAN/S PERVISOR <br /> R -g 1171C�`l rlvz 00 �~, C T HT1 <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1137 SOUTH STOCKTON STREET S. RIVER RD. <br /> COUNTY ZIP <br /> CITY 95206 <br /> S70CKTCN SAN JOACiUIN <br /> CITY =,=; <br /> TATE ZIP <br /> MAILING ,ADDRESS ?7 <br /> -_ _ ,� _T A "� <br /> 9t <br /> P.O. BOX r(T / eJ�.t" <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209_4� 4 ( 1 01 GASOLINE STATION (X) 02 OTHER MAINTENANCE FACILITY <br /> NU.`1BEP. 4F CONTAINEaS <br /> PUPAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 4 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FI?ST) AND PHONE W/AREA CODE NIGHTS: NAME(yL�AST NATE FIRST) AND PHONE W>AREA OODE <br /> 209-X48-3s99' 14,�r`?rl (�f� 209-4k&-3bA — Q <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 2 <br /> B. MANUFACTURER (IF APPROPRIATE)' YEAR MFG: C. YEAR INSTALLED 1979 C l UNKNOWN <br /> D. CONTAINER CAPACITY: 12000 GALLONS ( 1 UNKNOWN E. DOES THE CONTAINER STORE i ) 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 /> ( ) 01 UNLEADED f ] 02 REGULAR ( } 03 PREMIUM (X) 04 DIESEL ( ) 05 WASTE OIL f 1 06 OTHER <br /> V CONTAINER CONSTRUCTION C.' <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ] GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( 1 03 UNKNOWN <br /> C. ( ] O1 DOUBLE WALLED ( ) 02 SINGLE WALLED ( ) 03 LINED <br /> D., ( 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> [ ) 06 ALUMINUM ( l 07 STEEL CLAD ( 1 08 BRONZE C 1 09 COMPOSITE ( 1 10 NON-METALLIC <br /> 9_X4-12 UNKNOWN ( ] 13 OTHER: <br /> PAGE 1 <br /> NSC04-070185 (10/18/85) <br />