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-P, T / l�� .� • STATE ID NUMBER 000000368770 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAG TANK <br /> (1(S <br /> 01 NEW PERMIT ( l 05 RENEWED P€RMIT .2:�i07 TAW CLOSED ( 09 DELETE FROM. FILE (NO FEE) <br /> �T 02 CONDITIONAL PERMIT ( 7 06 AMENDED PERMIT ( 1 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> SAN JOAQUIN COUNTY ( ) 01 FED ( 1 02 STATE ( Y 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> SIRE P ADDRESa61 STOCKTON CA 9520i�7� <br /> II FACILITYY , <br /> FACILITY NAME .7LM`�o0.' (.L�V�Cu,— t ER/FOREMAN/SUPERVISOR <br /> 1 Nan <br /> STP--.-. A�OPESS NEAREST CROSS STREET <br /> 444 S. WILSON WAY <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95201 <br /> MAILING ADDRESS <br /> CITY STATE ZIP <br /> P.O. BOX 1810 STOCKTON CA 95201 <br /> PHONE W/AP.EA CODE TYPE OF BUSINESS <br /> 209-944-4&9+- Xfj ( ) 01 GASOLINE STATION" (X) 02 OTHER D- <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LASTT1(1NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> ry(gYCt 15� )POP 209-944-2YW3t <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION tC <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER/. -if <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 309 GALLONS(UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES (X) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( 1 01 UNLEADED ( 1 02 REGULAR f 1 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( 1 INCHES ( ] CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) f ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED02 SINGLE WALLED ( 1 03 LINED <br /> D. ( ) 01 CARBON STEEL ( 1 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( l 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />