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• • STATE ID NUMBER 00000036877001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> GAtl.Al NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> f ) 02 CONDITIONAL PERMIT [ 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> SAN JO.AQUIN COUNTY '-` - ( ) O1 FED f ) 02 STATE _0tt 03 LOCAL <br /> CITY STATE ZIP <br /> STREET .ADDRESS STOCKTON CA �A§(9.5202 <br /> -262 E. Weber Street <br /> II FACILITY / <br /> FACILITY NAME .[A,Y\ 100- U+1 6b.-Wr Sin WD-y LR1'MLf / DEAL ER/FnPPMAN/SUP VISOR <br /> STREET ADDRESS NEAREST CROSS STREET ' <br /> 444 S. WILSON WAY DELLA ST <br /> CITY .COUNTY ZIP <br /> STOCKTON SAN <br /> JOA 95201 <br /> MAILING ADDRESS CITY STATE ZIP <br /> P.O. BOX 1810 STOCKTON 'CA 95201 <br /> PHONE W/APFa COTE TE OF BUSINESS <br /> (P) 01 GASOLINE STATION (X) 02 OTHER �K- 4 Ma k r <br /> 209-944�"��j <br /> F <br /> MBER OP CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> f! <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAMEf LAST NAM FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> OG00pCSMCA.(`0.L� �pL.y(n 209-944-2't9'f37"3"-�" '�� 1�(SpeL'�cher 201-9V�' �-�-�� <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) Cl TANK ( ] 04 OTHER: .CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): NONE YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> lama <br /> D. CONTAINER CAPACITY: GGB00' GALLONS ( ] UNKNOWN JE. DOES THE CONTAINER STORE: ( ) O1WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WA (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIAT€ BOX(ES): <br /> 01 UNLEADED ( ) 02 REGULAR ( ] 03 PREMIUM (XESEL ( 1 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. f l 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) �1.�) 02 NON-VAULTED Zo3 UNKNOWN <br /> C. f ) 01 DOUBLE WALLED _UCr 02 SINGLE WALLED ( ) 03 LINED <br /> D. ( 7 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE f 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( l 08 BRONZE f ) 09 COMPOSITE f ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> PAGE 1 <br /> HSC04-070185 (10/18/85) <br />