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0 STATE IO NUMBER 00000013749002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> F�( <br /> 1_O1 NEW PERMIT [ 1 OS RENEWED PERMIT [ 1 07 TANK CLOSED [ 1 09 DELETE FROM FILE (NO FEE) <br /> 1 02 CONDITIONAL PERMIt i 1 06 AMENDED PERMIT ( 1 08 MIt{OR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CCRPCRATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CIRCLE K CORPORATION i J 01 FED i 1 02 STATE f l 03 LOCAL <br /> STREET ADDRESS CITY STATE :TZ:,EP4500 SOUTH 40TH STREET PHOENIX AZ 0 <br /> II FACILITY <br /> FLCILITY NAME DEALER/FOREMAN,/SUPERVISOR <br /> CIRCLE K #1334 <br /> S'TPEET ADDRESS NEAREST CROSS STREET <br /> 2650 MI DIABLO ST. <br /> CITY COUNTY L95203E <br /> STOCKTON SAN JOAQUIN <br /> MAILING ADDRESS CITY ST2650 MI DIABLO ST. STOCKTON A42" <br /> PHONE W/APER CODE TYPE OF BUSINESS <br /> At�V465-4763 (X) 01 GASOLINE STATION i ) 02 OTHER <br /> NUMBER OF CONTAINERSRURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> kDAYS; N.4ME(LAST NAME FIRST[ AND PHONE W/AREA CODE NIGHTS: N.4ME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> rw <br /> 916-331-2540 — <br /> - <br /> COMPLETE THE FOLLOWING ON A SEPARATE 'FORM FOR EACH CONTAINER <br /> IV DESCRIPTION _. <br /> A. CX) 01 TANK ( ) 04 OTHER' CONTAINER NUMBER 2 <br /> B. MANUFACTURER (IF APPROPRIATE]: YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY= 8000 GALLONS i ) UNKNOWN E. DOES THE CONTAINER STORE f 1 OI WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( l 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> (X) 01 UNLEADED d ) 02 REGULAR ( ) 03 PREMIUM ( 1 04 DIESEL ( 1 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f 1 GAUGE ( 1 INCHES ( ) CM (X) UNKNOWN <br /> B. ( 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON—VAULTED ( ) 03 UNKNOWN <br /> C. f ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( ) 03 LINED <br /> O. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 'FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 1 07 STEEL CLAD f 1 08 BRONZE ( D 09 COMPOSITE ( ) 10 NON—METALLIC <br /> ( 1 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />