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STATE ID NUMBER 00000008201001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 01 NEW PERMIT f ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> l 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( 1 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAM!(CORPOPATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> Y 5 ( ) 01 FED t 102 STATE ( 1 03 LOCAL <br /> STREET T F.EE� AD E9��SDcv /' CITY STATE all` <br /> ((' Eu <br /> { eeKTOM- D U <br /> II FACILITY <br /> FACILITY NAM! DEALEP/FOP EMAN,SUPERVISOR <br /> STOCKTON ASSEMBLY SITE {�g�,0�. iNL�) <br /> .STREET ADDPESS NEAREST CROSS STREET <br /> 2894 MONTE DIABLO I-5 <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95203 <br /> MAILING 4DDPSSS CITY STATE ZIP <br /> S3S99204- CA 9644&�C�6 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> M9-94Y'=82b'3 10 7)92Y-5 ol I ( ) 01 GASOLINE STATION (X) 02 OTHER CONSTRUCTION YARD <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 2 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(L ST NAME FIRST) AND PHONE W/AILEA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> 7- <br /> �.�-„ y r. <br /> COMPLETE THE FOLLOWING ON A SEPARAT FO t FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: 1982 C. YEAR INSTALLED 1982 [ ) UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS ( ) UNKNOWN E, DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X1 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> (XI 01 UNLEADED ( 1 02 REGULAR ( ) 03 PREMIUM ( 1 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( 1 INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( 1 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( ] 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM f 1 07 STEEL CLAD ( ) 08 BRONZE f l 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />