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• • STATE ID NUMBER 00000011294001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> wo1 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM.FILE (NO FEE) <br /> TT 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPOPATION,INDIVIDUAL R PUBLIC AGENCY) <br /> CITY OF STOCKTON PUBLIC AGENCY ONLY <br /> ( ) <br /> 01 FED ( ) 02 STATE LW 03 LOCAL <br /> STREET ADDRESS <br /> 425 N. EL DORADO carr srA.rE ZxP <br /> STOCKTON CA 95202 <br /> II FACILITY <br /> FACILITY NAME G D '�Lk 6,0//DEALER/FOREMAN/SUPERVISOR <br /> OMPANY OFFICERS <br /> STREET ADDRESS <br /> 1211 E SWAIN NEAREST CROSS STREET T <br /> CITY <br /> STOCKTON COUNTY ZIP <br /> SAN JOAQUIN 95210 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 1211 E SWAIN STOCKTON CA 95210 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-951-9334 ( ) 01 GASOLINE STATION (X) 02 OTHER FIRE STATION <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> I N/A <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME NAME NAME FIRST) Allo PHONE W/AREA CODES: NAME(LAST NAME FIRST)) AND PHONE W/AREA CODE r 9 Yo55��io5�8 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINERNUMBER,,�3� <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN Y EAR MFG: C. YEAR INSTALLED 1980 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 5 0 GALLONS ( ) UNKNOWN E. OES THE C <br /> DONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> I <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( 1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL ( ) 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> D <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( 1 INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN IN UNDERGROUND VAULT) ( l 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( l 01 DOUBLE WALLED (xf 02 SINGLE WALLED ( ) 03 LINED <br /> D., ( ) 01 CARBON STEEL f ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD f ) 08 BRONZE [ 1 09 COMPOSITE ( 110 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> ISC04-070185 (10/18/85) <br /> PAGE 1 <br /> i « <br />