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STATE IA NUMBER 00000000655005 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> rMONTECORPORATICN <br /> NEW PERMIT ( ) 05 RENEWED PERMIT ( 1 07 TANK CLOSED f 1 09 DELETE FROM FILE (NO FEE) <br /> CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> WNERPPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> E CORPORATION ( ) 01 FED ( 1 02 STATE ( ) 03 LOCAL <br /> DDRESS CITY STATE ZIPMINER AVE. STOCKTON CA 95209 <br /> ACILITYY NAME DEALER/FOREMAN/SUPHRVISOR <br /> TE CORPORATICN #33 RAY MEDEL <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 2716 E. MINER AVE. FILBERT AVE. <br /> CITY F COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95205 <br /> MAIL_NG ADDRESS CITY STATE ZIP <br /> P.O. BOX 8010 STOCKTON CA 95208 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-466-9011 ( ) O1 GASOLINE STATION (X) 02 OTHER FOOD PROCE5SOR <br /> NUMBER OF CON--+AINEP.S RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 5 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> FMAUL�HARDTq <br /> NAME(LAST N-4-S FIRST] AND PHONE W/AREA CODE NIGHTS: N.AME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> MIKE 209-466-9011 MEDEL, RAY 209-463-2036 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 5 <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: GALLONS (X) 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 ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> E ) 01 UNLEADED (X) 02 REGULAR ( ) 03 PR€MIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: i 1 GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. f ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) C ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( ) 03 LINED <br /> D. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL f 1 03 FIBERGLASS C ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM f 1 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( 1 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE I <br />