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STATE ID NUMBER 00000036877002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> NEW PERMIT f 1 05 RENEWED PERMIT ( l 07 TANK CLOSEDtl09 RELETE FROM FILE tN0 FEE1 <br /> ;Lk;)' Ol <br /> 02 CONDITIONAL PERMIT i ) 06 AMENDEt3 PERMIT ( 1 OS MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPOPATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> SAN .lOA4UTN COUNTY { ) 01 FED ( ) 02 STATE (.\ 03 LOCAL <br /> STREET ADDRESS <br /> CITY STATE ZIP <br /> STOCKTON C4 <br /> II FACILITY <br /> FACILITY NAME S 10 (,( n V✓` DEALER/FOPEMAN 'SUPEPVISOP o+, <br /> d r-rn "—5/?LQt'Yt9. <br /> t s <br /> ST=EET ADDRESS NEAREST CROSS STREET <br /> 444 S. WILSON WAY DELLA ST <br /> COUNTY ZIP <br /> CITY 95201 <br /> STOCKTON SAN JOAQUIN <br /> M-.)LING ADDRESS CITY STATE ZIP <br /> CA 95201 <br /> P.O. BOX 1810 STOCKTON <br /> PHONE W/AREA CODE TYPE OF BUSINESS A� <br /> 209-944- <br /> ( ) 0 <br /> 1 GASOLINE STATION (X1 02 OTHER " � ` x- .-..K- .,gEn f`i " r pool— <br /> NL:MSER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> III 24 FLOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST N ME FIPST) AND PHONE W/AREA CODE <br /> NIGHTS: N.4ME(L►A�ST/NAME FIRST) Ap�N�DL�RHO �W%AREA CODE <br /> L�317�4LIf7Jl�S� L7�( 209-944-�,i j� t/i5 'cd—, er <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK i ) 04 OTHER: CONTAINER NUMBER 2 <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: C. YEAR INSTALLED fXl UNKNOWN <br /> /�,oac <br /> D. CONTAINER CAPACITY: 609 GALLONS ( ) UNKNES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR W OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( D 01 UNLEADED ( ) 02 REGULAR ( l 03 PREMIUM (X) 4 DIESEL t ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES t ) CM (X) UNKNOWN <br /> B. { 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) � 02 NON-VAULTED 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED i.�>L4 02 SINGLE WALLED ( 1 03 LINED <br /> D. ( } 01 CARBON STEEL C ) 02 STAINLESS STEEL d 1 03 FIBERGLASS ( l 04 POLYVINYL CHLORIDE ( } 05 CONCRETE <br /> ( ) 06 ALUMINUM ( l 07 STEEL CLAD ( 1 08 BRONZE C ) 09 COMPOSITE t } 10 NON-METALLIC <br /> (X) 12 UNKNOWN f ) 13 OTHER: <br /> PAGE 1 <br /> HSC04-070185 (10/18/65) <br />