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• • • • STATE ID NUMBER 00000009692002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> bd O1 NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ') 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> N4ME(CORPOPATION,INDIVZOUAL OR PUDLIC AGENCY) NPUBLIC AGENCY ONLY <br /> S7GN �(2o Duc-TS .�tU G- ( l 01 FED i ) 02 STATE (,& 03 LOCAL <br /> ;TR EET ADDRESS b E'wx 3l� ( CITY - STATE ZIP <br /> 477 Q-1QORr creccr enr�� 1W 06157- CA <br /> ys 3�3 <br /> iI FACILITY <br /> `ACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> :JSP-STOCKTON PLANT <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 711 S. MADISON SCOTT <br /> CITY COUNTY ZIP <br /> 'STOCKTON SAN JOAQUIN 95201 <br /> MAILING ADDRESS .CITYSTATE ZIP <br /> P.O. BOX 387 STOCKTON CA 95201 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-948-3311 ( ) 01 GASOLINE STATION (X) 02 OTHER CONCRETE <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAIS: NAME(LAST NAME FIRST) AND PHONE W/ARTA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> IIi4L�i�9'-' 209-948-3311 '-- ---- "-"--- 2?4�r�4-F}74 <br /> BZ VM 1F%cic� <br /> COMPLETE THE FOLLOWING ON A SEPARATFORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER WS10 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 5000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( 1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> (X) 01 UNLEADED ( ] 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( 7 05 WASTE OIL f 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED IX) 02 SINGLE WALLED ( ] 03 LINED <br /> 0. (X) 01 CARBON STEEL f 1 02 STAINLESS STEEL f ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( l 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> MSC04-070185 (10/18/85) PAGE 1 <br />