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STATE ID NUMBER 00000059504001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( l O1 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT f 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> ( ) O1 FED ( ) 02 STATE ( ) 03 LOCAL <br /> CLARENCE.BAROSSO <br /> STREET ADDRESS CITY STATE IIP <br /> 2438 E. MORODA LANE STOCKTON ICA 95210 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> CLARENCE BAROSSO <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 2438 E. MORODA LANE <br /> COUNTY ZIP <br /> CITY STOCKTON SAN JOAgUIN 95210 <br /> CITY STATE ZIP <br /> MAILING ADOPESs STOCKTON CA 95210 <br /> 2438 E. MORODA LANE <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-477-4543 ( 1 O1 GASOLINE STATION (X) 02 OTHER RESIDENCE <br /> NUMBER OF CONTAINERS <br /> RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 1 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> BAROSSO, CLARENCE 209-477-4543 SAME ' <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG C. YEAR INSTALLED (X) UNKNOWN <br /> 0. CONTAINER CAPACITY: 300 GALLONS ( ] UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOESTHE NER STORE VEHICLE <br /> F WASTE I L0f )E2 OL fI) SK APPROPRIATE BOX(ES) <br /> ((X) 01 UNLEADED ) 02REGULAR03PREMIUM04DIESEL 05 WASTEI06OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( 1 CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( 1 03 LINED <br /> D. ( 1(01 CARBON <br /> STAINLESS <br /> STEEL L08f03 BRONZEFIBERG09SCOMPOSITE POLYVINYL 10 05 CONCRETE <br /> NON-METALLIC( ) <br /> (X) 12 UNKNOWN l ) 13 OTHER: <br /> PAGE <br /> HSC04-070185 (10/18/85) <br />