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STATE ID NUMBER 00000021890003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ! O1 NEW PERMIT ( ) 05 RENEWED PERMIT ( l 07 TANK CLOSED ) 09 DELETE _FROM (NO�FEEI <br /> ( 1 02 CONDITIONAL PERMIT [ } 06 AMENBED PERMIT ( 1 08 MINOR CHANGE (�NOSUR�CHARGG(EI <br /> I OWNER <br /> N4ME(CO=PC=.ATION,INDIVIDVAL OR PUBLIC AGENCY) TPUBLIC AGENCY ONLY <br /> 01 FED ( l 02 STATE ( 1 03 LOCAL <br /> JOHN PHILLIPS <br /> TSTOCKTON <br /> TY STATE �95206 <br /> STREET ADDRESS CA <br /> P.O. BOX 6463 <br /> II FACILITYrr/�[��// <br /> FACILITY NAME rf,' "fS.� DEALER/FCUEMAN/SUP RVISOR <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1137 SOUTH STOCKTON STREET S. RIVER RD. <br /> COUNTY ZIP <br /> CiT'r 95206 <br /> STOCKTON SAN JOAQUIN <br /> MOILING ADDRESS <br /> CITY L STATE ZIP p <br /> CA "_em L 3 ©ro <br /> P.D. BOX ' i CQ`�f <br /> PHONE W/AREA CODE Tl'F�CIF USINESSASOLINE STATION (X) 02 OTHER MAINTENANCE FACILITY <br /> Nu!MBw_P OF CONTA1INERS �LA;EONLY : TOWNSHIP __JRANGE SECTION <br /> 4 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS! N.AME(LAST NAME FIRST? AND PHONE W/ARE�/A CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AP.EA CODE <br /> J+ �?I / 209-94&--I O'0• Y� �'' 5r` po 209-94$- <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK { l 04 OTHER: CONTAINER NUMBER 3 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1979 ( 1 UNKNOWN <br /> 0. CONTAINER CAPACITY: 2000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( 1 01 WASTE (X) 02 PRODUCT <br /> F. ODES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BO5 (ESl <br /> ( 1 01 UNLEADED ( } 02 REGULAR f 1 03 PREMIUM ( ) 04 DIESEL ( 1 05 WASTE OIL (X) 06 OTHER NtFo Q(( <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( 1 GAUGE ( ) INCHES ( ] CM (X) UNKNOWN <br /> B. ( 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) O1 DOUBLE WALLED f ) 02 SINGLE WALLED ( 1 03 LINED <br /> D. ()0 01 CARSON STEEL ( } 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> `( ) 06 ALUMINUM [ l 07 STEEL CLAD ( } 08 BRONZE ( l 09 COMPOSITE t ) 10 NON-METALLIC <br /> (-l4 12 UNKNOWN ( } 13 OTHER <br /> PAGE 1 <br /> HSC04-070185 (10/18/85) <br /> • i <br />