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t STATE IO NUMBER 00000048924001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 44L(7�1 01 NEW PERMIT ( 1 05 RENEWED PERMIT ( 1 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 1 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NiME(CORPORATICN.INDIVIDUAL OR PUBLIC AGENCY) - PUBLIC AGENCY ONLY <br /> E NATIO ( ) 01 FED ( ) 02 STATE ( 1 03 LOCAL <br /> STREET ADDRESS CITY _FF <br /> TATE ZIP <br /> 2050 KINGS ROAD JACKSONVILLE FL 32203 <br /> II FACILITY <br /> FACILITY NAME DEALER/FCREMAN/S PERVISOR <br /> JC:kfPIE NATIONWIDE, INC. ! � <br /> STREET ADDRESS NE EST CRO$$ STREET <br /> 2007 N. WILSON WAY !`5�0 <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAWUIN 95205 <br /> MAILIN^u APD?ESS CITY STATE 22P <br /> 2007 N. WILSON WAY STOCKTON CA 95205 <br /> PHONE W/AREA CODE IrYPE F BUSINESS <br /> 209-464-7704 ( ) 0l GASOLINE STATION (Xl 02 OTHER TRUCK TERMINAL <br /> NUMBER CF CONTAINERS UF.AL AREAS CNLY : TOWNSHIP RANGE. SECTION <br /> .+� 1 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAPS: NA-ME(LAST NAME FIRST) ANP PHONE W/AREA CODE NIGHTS: NAMEtLAST NAME FIRST) AND PHONE W/AREA CODE <br /> HERRON, W.L. 315-455-5657 HERRON, W.L. 209-952-2532 <br /> COMPLETE THE ,FOLLOWING ON A SEPARATE FORA FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> 4 <br /> A. (X) 01 TANK ( 1 04 OTHER: CONTAINER NUMBER 00009 8901 <br /> B. MANUFACTURER (IF APPROPRIATE): 1-669 YEAR MFG= C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 15000 GALLONS ( l 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 /> ( l 01 UNLEADED f 1 02 REGULAR ( 1 03 PREMIUM (X) 04 DIESEL [ 1 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( 1 INCHES ( 1 CM (X) UNKNOWN <br /> B. [ l 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED 02 SINGLE WALLED ( 1 03 LINED <br /> 0. (X) 01 CARBON STEEL ( 1 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( 1 06 ALUMINUM ( 1 07 STEEL CLAD ( 1 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( ) 12 UNKNOXN f ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />