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• /.4 • STATE ID NUMBER 00000000955001 <br /> APPLICATION FOR PERMIT TO ERATE UNDERGROUND STORAGE TANK <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> N.,ME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> ROEK BROTHERS ( ) 01 FED ( ) 02 STATE ( 1 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 3736 S. HIGHWAY 99 STOCKTON CA 95205 <br /> II FACILITY <br /> F4-:LITY NAME ,6o (, b r D ('a.� �J DEALER/FOREMAN/SUPERVISOR <br /> AMERICAN�=vRR ST oP ".:'s- A-- -- <br /> c <br /> STPEES P.DDPESS NEAREST CROSS STREET <br /> 17267 N. SUNRISE <br /> CITY COUNTY ZIP <br /> VICTOR SAN JOAQUIN 4*95253 <br /> MAILING ADDRESS CITYSTATE ZIP <br /> 17267 N. SUNRISE VICTOR CA 4W95253 <br /> PHONE W/AREA COD n k 2dD TSP <br /> ba ) 01 GASOLINE STATION (X) 02 OTHER <br /> E OF BUSINESS <br /> 209-464-8344- d l ]�(l/ <br /> NUMBER. OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 1 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CORE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> a,»r 'j <br /> - - 209 &uA 3i�!-�(e3a �- Lp <br /> LkIA OMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( 1 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: �;L 00 GALLONS (X) UNKNOWN E. DOES THE CONTAINER STORE: C ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER TORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES ( 1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED 1.,02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( l 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( 1 CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ON-VAULTED ( 1 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED INGLE WALLED f 1 03 LINED <br /> 0. ( ) 01 CARBON STEEL O 02 STAINLESS STEEL f 1 03 FIBERGLASS C ) 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( 1 08 BRONZE ( 1 09 COMPOSITE ( 1 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />