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STATE IO HU BERP� <br /> aaY' )i'= <br /> APPLICATION FOR ERMIT TO OPERATE UNDERGRO STORAGE TARS° <br /> _ 7 t ,_ - LJ_o9.1fELEZE..F.RXIILF� • LNO..fEE)._ <br /> _51 NE"ERMIi t , OS,1tENEWED_PERMI A8 MINOR <br /> CCHANG <br /> _,f 1 O2 CONDITIONAL PERMIT l 1 06 AMENDED PERMIT ( ) OB MINOR CHANGE (NO SURCHARGE! <br /> I OWNER <br /> NAM[(COR►DRAT ION,INDIVIDUAL Of PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> San Joaquin Local Health District ( 1 01 FED ( ) 02 STATE Uti OS LOCAL <br /> SA <br /> IP <br /> $zlLcrEAODI�e�er St. D�STtockton CA �J5202 <br /> ILIO FACILITY <br /> .FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> San Joaquin Co. - Jail Complex e ave <br /> .$TREAT ADDRESS NEAREST CROSS STREET <br /> 999 W. Mathews Rd. Wolf P_ <br /> COUNTY IIP <br /> 'CITY 05231 <br /> French Cam San Joa uin <br /> CITY STATE IIF <br /> 'MAILING ADDRESS SToc-kton CA 95205 <br /> 1722 E. Scotts Ave. <br /> PHONE N/AREA CODE TYPE OF lUfINlff <br /> ! 209-982-1604 ( ) 01 GASOLINE STATION (X) OE OTHER Jai <br /> , <br /> �UMAE* OF CONTAINERS RURALAREASONLY Y TOWNSHIP RANGE fCC7jON <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAM (LAST NAME FIRST) AtA pM(lNE„N(/LR,E4 COO! NIGHTS: NAMC(LAST NAME FIRST) AND PHONE W/ARRA CODE <br /> Soave �eo LUUY J2SL IbU Disoathcer 09 944 22 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. LNd 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 3 <br /> B. MANUFACTURER (IF APPROPRIATELY YEAR MFG: C. YEAR INSTALLED Odw LMNOWN <br /> 0. CONTAINER CAPACITY: .2 SD GALLONS ( 1 UNKNOWN E. DOES THE CONTAINER STORE: 1 101 WASTE 0f'02 PRODUCT <br /> Y. DO, O 04 <br /> DOES THE <br /> CONTAINER <br /> ( STORE <br /> ERMOTOR VEHICLE LE FUEL ORMWASTE OIL <br /> OIESE 01 IYES <br /> 05 NAST020NO IIF YES <br /> OCHECK APPROPRIATE SOX(ES): <br /> LEADED <br /> l 02 <br /> V CONTAINER CONSTRUCTION <br /> IA. THICKNESS OF PRIMARY CONTAINMENT: [ F GAUGE C'J INCHES ( 1 CM (1,4- UNKNOWN <br /> i. <br /> 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) lhr 02 NON-VAULTED 1 1 03 UNKNOWN <br /> 01 DOUBLE WALLED (R4 02 SINGLE WALLED 1 1 03 LINED _-- <br /> I:O. <br /> Od 01 CARBON STEEL 1 ) 02 STAINLESS STEEL ( 103 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE 1 1 05 CONCRETE <br /> ( ) 06 ALUMINUM 1 107 STEEL CLAD ( 1 08 BRONZE 1 109 COMPOSITE t 1 10 NON-METALLIC <br /> 1 1 12 UNKNOWN l 113 OTHER: ---- <br /> PAGE 1 <br /> IISC04-070185 (10/18/85) <br />