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VIM* 0 <br /> STATE ID NUMBER 00000004374001 <br /> APPLICATION FOR PERMIT TO OPER ESUNDERGROUND STORAGE TANK <br /> E( <br /> ] <br /> 01 NEW PERMIT E 1 05 RENEWED PERMIT <br /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT 1' L 07 INO CLpSEGE (NO SURCHARGE)) 09 DELETE FROM FILE (NO FEE) <br /> I OWNER <br /> NAME(COPPOPATION�INDIVIOUAL OR PUBLIC AGENCY) <br /> STEPHE14S MARINE, INC. PUBLIC AGENCY ONLY <br /> ( ) 01 FED ( ) 02 STATE ( 1 03 LOCAL <br /> STF,EET "COPESS <br /> 345 N. YOSEMITE STREET CITY �=qz.Z5 <br /> STOCKTON CA03 <br /> II FACILITY <br /> FACILITY NLME <br /> STEFHENS MARINE. INC. DEALER/FOREMAN/SUPERVISOR <br /> RICHARD B. DUNN <br /> STPEET ADDRESS <br /> 345 N. YOSEMITE STREET NEAREST CROSS STREET <br /> FREMONT <br /> CITY <br /> STOCKTON COUNTY ZIP <br /> SAN JOAQUIN 95203 <br /> MAILING ADDRESS <br /> IP <br /> P.D. BOX 670 CITY STATE 92 <br /> STOCKTON CA 95201 <br /> PHONE W/AP,EA CODE TYPE OF BIP <br /> USINESS <br /> 209-466-8591 (X) 01 GASOLINE STATION ( l 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP <br /> 1 RANGE SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> C4YS: NAME{ LAST NAME FIRST] AND FMONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> RICHARD DUNN 209-466-6691 THEO STEPHENS <br /> 209-466-8691 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 03 TANK f ) 04 OTHER: <br /> CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 500 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( l OI WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? <br /> NO <br /> (X1 01(UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL O( )E05 WASTE 2OIL [I) 06SOTHERK APPROPRIATE BflX(ESI: <br /> V CONTAINER CONSTRUCTION <br /> E <br /> HICE OF PRIMARY CONTAINMENT: [ ) GAUGE f ) INCHES ( ) CM (Xl UNKNOWN <br /> ) LTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( l 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( ] 03 LINED <br /> D. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> f ) 06 ALUMINUM (X) 07 STEEL CLAD f ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( } 12 UNKNOWN ( ) 13 OTHER: <br /> ISC04-070185 (10/18/85) <br /> PAGE 1 <br />