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STATE ID <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE NUMBER 00000031639003 <br /> 02 NEW PERMIT ( ) 05 RENEWED PERMIT TANK <br /> 02 CONDITIONAL PERMIT ( ) 05 AMENDED PERMIT <br /> ( 1 07 TANK CLOSED <br /> ( 7 08 MINOR CHANGE (NO SURCHARGE)) 09 DELETE FROM FILE (NO FEET <br /> I OWNER <br /> NAME(CORPORATIONS INDIVIDUAL OR PUBLIC AGENCY) <br /> CITY OF STOCKTON <br /> STREET ADDRESS <br /> PUBLIC AGENCY ONLY <br /> ( 7 <br /> 42 01 FED ( ) 02 STATE <br /> 5 N. EL DORADO ST CITY 03 LOCAL <br /> STOCKTON STATE ZIP <br /> II FACILITY CA 95201 <br /> FACILITY NAME (✓('E J J y� <br /> Ad DEALER/FOR <br /> EMAN/SUPERV <br /> ISOR <br /> STREET ADDRESS C_ � <br /> 22 E. MARKET Si �nl LL,rt� <br /> NEAREST CROSS STFEET <br /> CITY EL DORADO ST. <br /> STOCKTON -------— <br /> COUNTY ---- <br /> M.:ILING ADDRESS SAN JOAQUIN ZIP <br /> 22 E. MARKET ST CITY 95201 <br /> -'-- <br /> PHONE W/ARSA CODE STOCKTON STgTE IIP <br /> CA 95201 <br /> 209-944 _ g&0�?. TYPE of eusxNEss <br /> NUMBER OF CONTAINERS ( ) 01 GASOLINE STATION (X) 02 OTHER PUBLIC AGENCY <br /> 3 RURAL AREAS ONLY : TOWNSHIP <br /> RANGE <br /> SECTIOry <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> ' 209-944-8B4(r %00 NIGHTS: NAMEf LAST NAME FIRST) AND <br /> PHONE W/gREA CODE <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK t ) 04 OTHER: <br /> CONTAINER NUMBER-lq Z <br /> B. MANUFACTURER (IF APPROPRIATE): <br /> YEAR MFG: C. YEAR INSTALLED 1968 ( l UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( 7 01 WASTE (X) 02 PRODUCT <br /> MOTOR <br /> F OES X7 01 THECONTAINERNER STORE02REGULAR VE(S)LE FUEL ORMWASTE 0ILOIE(XI ( ) 05 WASTE OIL ( ) 06 OTHER <br /> (EL 01 YES ( 1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> CONTAINER CONSTRUCTION <br />. THICKNESS OF PRIMARY CONTAINMENT: 1/4 PLA ( 7 GAUGE ( ) INCHES f ) CM f ) UNKNOWN <br /> ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE f 7 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( 7 10 NON-METALLIC <br /> f 1 12 UNKNOWN ( ) 13 OTHER: <br /> D4-070185 (10/18/85) <br /> PAGE 1 <br /> • <br /> 0 <br />