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STATE ID NUMBER 00000003446003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( 1 09 DELETE FROM FILE (NO FEE) <br /> l 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CCRPORATION.INCIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> GIBRALTER COMMUNITY BUILDERS ( ) 01 FED ( ) 02 STATE ( ? 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 5713 N. PERSHING AVENUE STE E STOCKTON CA 95207 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> SADDLE CITY CHEVRON RICHARD BOKIDES <br /> 4,TP.EET ADDRESS NEAREST CROSS STREET <br /> 6421 W. PADDOCK PLACE HIGHWAY 12 <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN <br /> MAILING ADDRESS CITY STATE ZIP <br /> W. PADDOCK PLACE 7�LODI CA 95240 <br /> PHONE W/AREA CODE TYPE OF BUSINISS <br /> 209-334-0975 (X) 01 GASOLNE STATION ( ) 02 OTHER <br /> NUMBER. OF CONTAINERS <br /> .5 <br /> AREAS ONLY TOWNSHIP RANGE SECT:CN <br /> 5 <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 /> RICHARD BOKIDES 209--9rP034-47G <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBERE3 <br /> B. MANUFACTURER (IF APPROPRIATE): ARROW TANK CO YEAR MFG 1953 C. YEAR INSTALLED 1983 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 12000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE= ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINE EHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( l 01 UNLEADED (X) 02 REGULAR ( l 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1/4 ( ) GAUGE (X) INCHES ( ) CM [ ) UNKNOWN <br /> B. ( 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( l 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( l 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( l 04 POLYVINYL CHLORIDE ( ) 05 CCNCP.ETE <br /> ( ) 06 ALUMINUM ( l 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> t 1 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />