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• • STATE I0 NUMBER 00000042162001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TAN <br /> ( 1 <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( 1 07 TANK CLOSED 09 DELETE FROM FILE LaLl <br /> ( ) 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHAR <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> DON LEACH ( ) 01 FED ( 1 02 STATE ( 1 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 919 SHULL PLACE STOCKTON CA 95209 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> DONCO DON LEACH <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 230 N. STOCKTON ST. LOCKFORD ST. <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESS .CITY STATE ZIP <br /> 3355 N., AD ART RD STOCKTON CA 95205 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-931-6950 ( ) 01 GASOLINE STATION (X) 02 OTHER FARM MACHINERY <br /> NUMBER OF CONTAINERS PUPAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAMEILAST NAME FIRST) AND PHONE W/AREA CODE <br /> LEACH, DON 209-931-6950 LEACH, DON 415-865-3548 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK f 1 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 300 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 /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL ( 1 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( 1 INCHES ( 1 CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) f ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ! ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( ] 03 LINED <br /> 0. f 1 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM f ) 07 STEEL CLAD f ] 08 BRONZE f ] 09 COMPOSITE f ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( 1 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />