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STATE I0 NUMBER 00000042162002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND ST <br /> ( ) 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED <br /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHA 9 DELETE FROM FILE (NO FEEL <br /> I OWNER <br /> NAME(CORPOPATION,INDIVIDUAL OR PUBLIC AGENCY) <br /> DON LEACH PUBLIC AGENCY ONLY <br /> ( ) 01 FED ( ) 02 STATE ( ] 03 LOCAL <br /> STREET ADDRESS <br /> 919 SHULL PLACE CITY STATE IIP <br /> STOCKTON CA 95209 <br /> II FACILITY <br /> FACILITY NAME <br /> OONCO DEALER/FOREMAN/SUPERVISOR <br /> DON LEACH <br /> STREET ADDRESS <br /> 230 N. STOCKTON ST. NEAREST CROSS STREET <br /> LOCKFORD ST. <br /> CITY <br /> LODI COUNTY ZIP <br /> SAN JOAQUIN 95240 <br /> MAILING ADDRESS <br /> 3355 N. AD ART RD CITY STATE ZIP <br /> STOCKTON CA 95205 <br /> PHONE W/AP.:.A CODE TYPE OF BUSINESS <br /> 209-931-6950 f ) 01 GASOLINE STATION (X) 02 OTHER FARM MACHINERY <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP <br /> 3 RANGE SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME( LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> LEACH, DON 209-931-6950 LEACH, DON <br /> 415-865-3548 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( 1 04 OTHER: CONTAINER NUMBER 2 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> 0. CONTAINER CAPACITY: 500 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 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 /> (X) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ] 05 WASTE OIL ( l 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> FTHICKNESS OF PRIMARY CONTAINMENT: ( 1 GAUGE f ) INCHES f ) CM (X) UNKNOWN <br /> 1 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> 1 DOUBLE WALLED ( ) 02 SINGLE WALLED ( ) 03 LINED <br /> CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> 06 ALUMINUM ( ) 07 STEEL CLAD ( ] 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> UNKNOWN f ) 13 OTHER: <br /> HSC04-070185 (10/18/85) <br /> PAGE 1 <br /> t <br />