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• • <br /> ( t STATE ID NUMBER 00000024773006 <br /> APPLICATION FOR PERMIT TO OPE('RATE UNDERGROUND STORAGE TANK <br /> ( ) <br /> 01 NEW PERMIT ( ] 05 RENEWED PERMIT ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE lN0 FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(QORPORATION,INDIVIDVAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> PACIFIC GAS AND ELECTRIC COWPA ( ) 01 FED ( ) 02 STATE f ) 03 LOCAL <br /> STREET ACOFESS CITY STATE ZIP <br /> 77 BEALE STREET SAN FRANCISCO CA 94106 <br /> II FACILITY J- <br /> FACILITY NAME VtC DEALER/FOREMAN/SUPERVISOR <br /> 0. <br /> ec .` 60, WILLIAM J. FRAZIER <br /> STREET ADDFESS NEAREST CROSS STREET <br /> 4040 WEST LANE ALPINE <br /> CITY COUNT\ ZIP <br /> STOCKTON SAN JOAQUIN 95204 <br /> MAILING ADOPESS CITY STATE ZIP <br /> P.O. BOX 930 STOCKTON CA 95201 <br /> PHONE W/AREA CODE TYPEOF BUSINESS <br /> 209-465-3867 ( ) 01 GASOLINE STATION (X) 02 OTHER PUBLIC UTILITY <br /> NUMBER, OF CONTAINERS RURAL AREAS ONLYTOWNSHIP RANGE SECTION <br /> 7 <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 /> DIVISION OPERATOR 209-465-6947 DIVISION OPERATOR 209-465-3867 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK t 1 04 OTHER: CONTAINER NUMBER 6 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1957 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 250 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: f ) 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 f ] 02 REGULAR ( ) 03 PREMIUM ( ] 04 DIESEL (X) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 12 (X) GAUGE ( ) INCHES ( ) CM ( ) UNKNOWN <br /> B. ( l 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL t 1 02 STAINLESS STEEL f 1 03 FIBERGLASS ( l 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 1 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> f ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />