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STATE ID NUMBER 00000021890004 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> G� `r` � 1 09 DELETE FROM FILE (NO FEE) <br /> � 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ).,Q7 �K CLOSER, " , <br /> _02 CCNOITIONAL PERMIT ( ) 06 AMENDED PERMIT 08 MINOR CHANGE (N0 SURCf�ARGE) <br /> I OWNER <br /> NAME(COPPCRAT-ON,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> ( ) 01 FED ( ) 02 STATE { ) 03 LOCAL <br /> JOHN PHILLIPS <br /> CITY STATE�95206 <br /> STPElT ADDnlSS <br /> _T Ty CA <br /> P.O. BOX 6463 <br /> II FACILITY <br /> FACILITY NAME rJ 'J DEALER/FOREM.AN/5ISD <br /> UP RVR <br /> is*"v-r4Wi4*nE-L+1itN <br /> STREET ADDRESS NEAPEST CROSS STREET <br /> 1137 SOUTH STCCKTON STREET S. RIVER RD. <br /> COUNTY ZIP <br /> STOCKTDN CITY SAN JOAQUIN 95206 <br /> MAILIN3 ADDRESS CITY ��f✓A / CAATE ZIP C5d� <br /> P.O. BOX � STD --�/�G <br /> PHONE W/APEA CODE TYPE OF BUSINESS <br /> 209_4 ( 1 01 GASOLINE STATION {X) 02 OTHER MAINTENANCE FACILITY <br /> o P.URAL AREAS DNLY TOWNSHIP PANG! SECTION <br /> N',:"BEP CF CCNTAINEPS <br /> 4 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS' NA.ME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIPST) AND PHONE W/AREA CODE <br /> �}gyuplyg,-GA.k 209-449��5 f L� l�Q �-� G 209-4 3=t5ft&- t 7cC� <br /> r� <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION - <br /> A. (X) 01 TANK S ) 04 OTHER: CONTAINER NUMBER 4 <br /> B. MANUFACTURER SIF APPROPRIATE) YEAR MFG: C. YEAR INSTALLED 1979 ( 1 UNKNOWN <br /> D. CONTAINER CAPACITY: 5000 GALLONS ( 1 UNKNOWN E. DOES THE CONTAINER STORE: (X) 01 WASTE ( 1 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( l 02 NO IF YES CHECK APPROPRIATE BOX(ES)- <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL (X) 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT= f l GAUGE ( 1 INCHES f } CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( 1 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED ( 1 02 SINGLE WALLED ( ) 03 LINED <br /> D. ), 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( } 04 POLYVINYL CHLORIDE f 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 1 07 STEEL CLAD ( 1 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> CH 12 UNKNOWN E ) 13 OTHER: <br /> PAGE 1 <br /> HSC04-070185 (10/18/85) <br />