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STATE 20 NUMBER <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE - TANK <br /> U(1 01 NEW PERMIT ` , l 1 as RENEWED PERMIT ( 1 07 TAMC CLOSED ( 1 OY DELETE FROM FILE (NO FEE) <br /> 1 1 02 CONDITIONAL PERMIT 1 1 06 AMENDED PERMIT ( 1 06 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER _— <br /> HAMS(CORPORATION,IMDTVIOUAI OR ►)AMIE AG[tiCrt __— PUBLIC AGENCY ONLY <br /> CO 1./l P Li '''''TTT��� l 1 01 FED ( 1 02 STATE ( 1 03 LOCAL <br /> STREET ADORES! - 'CITY STAT[ 22F, — <br /> 2LI31 t• MA 21 POSA RD . - I STOGKZCN C� �iS2oS <br /> II FACILITY _ <br /> FACILITY NAME DE&LER/fv[MFHISUPERVISOP <br /> T3, J . J . CO K4 PAN ( hJC . _ I.)ICI< kcs E4 <br /> STREET ADD KS! NEAREST CROSS fTPFCT <br /> ay 3 1 E. MAR I POSH Pb . F41C-1�{wa �t�1 F-kc -rA (GE 2d . <br /> CITY COUNTY IIP <br /> S-To c7J cAti �oAQLli ,J i GszoS <br /> &' MAILING ADDRESS CITY STATE IIP <br /> P. O , 30X 3001c) STOCKTaN CA gSzl :?-ool6 <br /> PHONE W%AREA coot TYPEOF RUSINEts <br /> 1 01 GASOLINE STATION (A 02 OTHER TPL4-Ck—(hJ6- CC) <br /> HN'-0ER CF CONTAINCPS RVPAL AREAS ONLY TONNSNIP PANG[ SECTION. - — <br /> Tw D <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: HAMF(LAST NAME fIPSTI AND PHONE W/Af FA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> JIM - 2oR - KC)S7-A WICK 20,T - 727- 5/ 72 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION / <br /> f A. W 01 TANM ( 1 02 OTHER: CONTAINER NUMBER tl 3-31 �.y <br /> 7Z, ` �7X✓' <br /> B. MANUFACTURER (IF APPROPRIATE): R C'D/;.1\ N g'/%L 0/�GYEAR MFG: ji C. YEAR IHSTALLEO4�( 1 UNKNOWN <br /> 0. CONTAINER CAPACITY: 12, O O 0 GALLONS 1 1 UNKNOWN E. DOES THE CONTAINER STORE: 1 1 01 WASTE SCI 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (>4 01 YES l 1 02 NO IF TES CHECK APPROPRIATE BOX(ES1: <br /> 1 1 01 UILEAOEO ( 1 02 REGULAR ( 1 03 PREMIUM " 04 DIESEL l 1 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> u <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1 �-- 1 1 GAUGE fXl INCHES ( 1 CH 1 1 lUa(N041t/ _- - <br /> B ( 1 O1 VAULTED (LOCATEDUNDERGROUND VAULT) '(X? 02 NON-VAULTED 1 1 03 UNKNOWN <br /> _ _AU _IN AN--ND------ ---_— _-- ----� bLe_Lonfa nm.ent, <br /> IC. (/k 01 O"LE W.LLLEO 1 1 02 SINGLE WALLED 1 1 03 LINED <br /> 0. IXI 01 CARBON STEEL 1 1 02 STAINLESS STEEL f 1 03 FIBERGLASS l 1 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE' <br /> ( 106 ALUMINUM 1 ) 07 STEEL CLAD 1 1 00 BRONZE N 1 09 COMPOSITE ( 1 10 NON-METALLIC <br /> --1 1 12 UIIKNOWN ( 1 13 OTHER: /= /49 A Pv G;, L A S S <br /> HSC04-0:0165 PAGE 1 <br />