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• • STATE ID NUMBER 0000003 13001 <br />n nrnmTT Tn nPFRATP HM DERGROUND STORAGE TANK <br />ArrL.L,A Iu.N run 1��1.1+.•. - <br />�I <br />fX )i NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br />022 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( 1 08 MINOR CHANGE (NO SURCHARGE) <br />I OWNER <br />FNAMCORPORATION� INDIVSOUAL OR PVBLIC AGENCY) <br />POL ENTERPRISES, INC. <br />T ADDRESS <br />W. WASHINGTON <br />PUBLIC AGENCY ONLY <br />( ) 01 FED ( ) 02 STATE ( 1 03 LOCAL <br />CITY STATE ZIP <br />STOCKTON CA 95203 <br />II FACILIIY <br />HUU'K <br />tMEKUC1lLT uunln l �^ <br />- <br />A. <br />DEALER/FOREMAN/SUPERVISOR <br />JA VS: NAME(LAST <br />RONALD OR MARVIN <br />FACILITY NAME - <br />NUMBER 01 <br />RONALD VANDEPOL <br />FIRST) AND PHONE <br />209-41"060-7457 <br />VANCO <br />B. <br />MANUFACTURER (IF APPROPRIATE): <br />YEAR MFG: <br />C. <br />YEAR INSTALLED (X) UNKNOWN <br />NEAREST CROSS STREET <br />STREET ADDRESS <br />O. <br />(ALPINE <br />> UNKNOWN <br />3230 N. WEST LANE <br />) 01 WASTE (X) 02 PRODUCT <br />F. <br />HNEREMOTOREGULAVEHIF <br />( ) alUNLEADEDX) 02 R ) 03 <br />WASTE 04LDIESEL 0( )E 05 WASTE2OIL <br />PREMIUM <br />(I) 065OTHERK APPROPRIATE BOX(ES)' <br />COUNTY <br />ZIP <br />CITY <br />SAN JOAQUIN <br />95204 <br />STOCKTON <br />STATE ZIP <br />MAILING ADDRESS <br />CITY <br />STOCKTON <br />CA 95204 <br />3230 N. WEST LANE <br />PHONE W/AREA CODE <br />TYPE OF BUSINESS <br />01 GASOLINE STATION ( ) 02 OTHER <br />209-463-5103 <br />(X) <br />RURAL AREAS ONLY <br />TOWNSHIP <br />RANGE <br />SECTION <br />NUMBER OF CONTAINERS <br />3 <br />nn\IT Af`T DCDCnAI <br />.II 24 <br />HUU'K <br />tMEKUC1lLT uunln l �^ <br />- <br />A. <br />(X) 01 TANK f 7 04 OTHER: <br />JA VS: NAME(LAST <br />RONALD OR MARVIN <br />NAME FIRST) AND PHONE W/AREA CODE <br />VAN DE P 209-465-3421 <br />NUMBER 01 <br />NIGHTS: NAME(LAST NAME <br />VANDEPOL RONALD <br />FIRST) AND PHONE <br />209-41"060-7457 <br />W/AREA CODE <br />—)5740 <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />-1n1 TTM\1 <br />LI <br />----.._ .--.. <br />- <br />A. <br />(X) 01 TANK f 7 04 OTHER: <br />CONTAINER <br />NUMBER 01 <br />B. <br />MANUFACTURER (IF APPROPRIATE): <br />YEAR MFG: <br />C. <br />YEAR INSTALLED (X) UNKNOWN <br />O. <br />CONTAINER CAPACITY: 10000 GALLONS ( <br />> UNKNOWN <br />E. DOES THE CONTAINER STORE: ( <br />) 01 WASTE (X) 02 PRODUCT <br />F. <br />HNEREMOTOREGULAVEHIF <br />( ) alUNLEADEDX) 02 R ) 03 <br />WASTE 04LDIESEL 0( )E 05 WASTE2OIL <br />PREMIUM <br />(I) 065OTHERK APPROPRIATE BOX(ES)' <br />V CONTAINER CONSTRUCTION <br />A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br />B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON -VAULTED (X) 03 UNKNOWN <br />C. ( ) 01 DOUBLE WALLED. (X) 02 SINGLE WALLED ( ) 03 LINED <br />D. (X1(01 06RALUMINUML (()) STAINLESS <br />STEEL 08(03 BRONZEFIBE 1 095 COMPOSITE POLYVINYL <br />NON-METALl 05 CONCRETE <br />LIC( <br />( 7 12 UNKNOWN ( ) 13 OTHER: <br />PAGE 1 <br />HSC04-070185 (10/18/85) <br />