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STATE 19 NUMBER 00000013749003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 01 NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ti ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( 1 08 MINOR CHANGE INO SURCHARGE) <br /> I OWNER <br /> NAME(COPPOPATION}INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CIRCLE K CORPORATION [ ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STPEET A.DDPESS CITY STATE ZIP <br /> 4500 SOUTH 40TH STREET PHOENIX AZ 85040 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN SUPERV SOP <br /> CIRCLE K #1334 j4"-eH*M=K w(2_ <br /> STPEET ADDRESS NEAREST CROSS STREET <br /> 2650 MI DIABLO ST. <br /> CITY COUNTY ZIP <br /> STOCKTON ISAN JOAQUIN 95203 <br /> MAILING .ADDRESS CITY STATE ZIP <br /> 2650 MI DIAB:LO ST. ISTOCKTON *tCyj 95203 <br /> PHONE W/APEA CODE TYPE OF BUSINESS <br /> 9't6-465-4763 (X) 01 GASOLINE STATION ( ) 02 OTHER <br /> 778ER OF CCNTAINEPS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAM! FIRST) AND PHONE W/AREA CODE NIGHTS. NAME(LAST NAME FIRST) AND PHONE WIAREA CODE <br /> 916-331-2540 - <br /> bt tc, zf"�- ci(Q2L� LETE <br /> PTHE FOLL0WING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK C ) 04 OTHER CONTAINER NUMBER 3 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS ( 1 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 ( 1 02 NO IF YES CHECK APPROPRIATE BOXiES)-' <br /> ( ) <br /> 01 UNLEADED ( ) 02 REGULAR iXl 03 PREMIUM ( ) 04 DIESEL ( ) 65 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( 1 INCHES ( ) CM (X) UNKNOWN <br /> 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( l 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED [ ) 02 SINGLE WALLED i ) 03 LINED <br /> 0. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( l 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( l 08 BRONZE ( ) 09 COMPOSITE f ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10✓18/85) PAGE 1 <br />