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• STATE ID NUMBER 00000036877004 <br /> APPLICATION FOR PERMIT TO OPERA UNDERGROUND STORA TANK <br /> O1 NEW PERMIT ( l 05 RENEWED PERMIT ( 07 TANK CLOSED 09 DELETE FROM FILE LNO FEE) <br /> 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( 1 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPORATIONrINDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> SAN JOAQUIN COUNTY ( ) O1 FED ( 1 02 STATE 03 LOCAL <br /> STREET ADDRESS , // CITY STATE ZIP <br /> Y8 2�-Z E WZ S 0CCKION CA 9520d�� <br /> II FACILITY /{� <br /> FACILITY NAME &,)) Jo (r1 (Q - Vjj5Or ^� (o VjP_X DEALER/FOREMAN/SUPERVISOR <br /> MY. �eeE-- De rz2.r <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 444 S. WILSON WAY DELLA ST <br /> CITY COUNTY ZE <br /> STOCKTON SAN JOAQUIN <br /> MAILING ADDRESS CITY STATEP.O. BOX 1810 STOCKTON CA <br /> PHONE 'W/APEA CODE TYPE OF BUSINESS Ltb -- _ FF <br /> B Ar <br /> 209-944 ^ ( ) 01 GASOLINE STATION (X) 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAKE(L ST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAMECLAST NAME FIRST) AND PHONE W/AREA CODE <br /> 209-944- 3 sulFr bis er -'V / <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 4 <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: GALLONS ( UNKNOWN E. DOES THE CONTAINER STORE: (X) 01 WASTE ( ) 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 ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL (X) 05 WASTE OIL ( 7 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS Of PRIMARY CONTAINMENT: ( ) GAUGE f ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (VO2 NON-VAULTED 1 03 UNKNOWN <br /> C. [ l 01 DOUBLE WALLED (A 02 SINGLE WALLED ( ) 03 LINED <br /> D. ( 7 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM f ) 07 STEEL CLAD ( ) 08 BRONZE C ) 09 COMPOSITE ( 1 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />