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RECUR <br /> G <br /> 1' STATE ID NUMBER 00000048386001 <br /> APPLICATION FOR PERA'i`� <br /> PERMIT TO OPER ' MA91Ol1ND STORAGE TANK <br /> {�C .01 NEW PERMIT ( l 05 RENEWED ';PERMIT ( ) 5N\MAJiVMhAl HEALTH 1 ) 09 DELETE FRO,-Ml <br /> t ) 02 CONDITIONAL PERMIT 06 AMENDED -PERMIT SURCHARGE) <br /> I OWNER <br /> x r,�cc�rP-PATICN.,NDiv_DUaI OR PL'9L:C AG=_NCYf ,. =PUBLICAGENCY ONLY <br /> STEPHEN J. GkROELLA, SR. FEE) ( ! 02 STATE t, l 03 LOCAL <br /> �T aDJRESS - <br /> :I:cv <br /> iTYSTATEZiP <br /> P.O. BOX 224 ICTOR; <br /> II FACILITY <br /> F.:__LITY NAME DEALER/FOPEMAN/SUP!RVISCP. - <br /> ISTEFANO'S GASOLINE STEPHEN GARDELILA 'HEALTH <br /> : E r <br /> a S-rR.E_T AC3iES5 NEAREST CPOSS 'STREET PERMIT/SERVICES <br /> 1419 E. CHARTER WAY WILSON WAY; <br /> CCUNTY <br /> STOC"TON SAN JOA6 fl <br /> r-.:L_NIO ADDRESS CITY <br /> P.O. BOX 224 VICTOR " <br /> :MCN! '.4/A;!A COOS T YPE OF bUSINESS ��`/d / V4 <br /> 204-368-12y8 [ 1 61 GASOLINE STATION (X <br /> 4U 5:P OF C JNT.1INs?$ RURAL An EAS 'ONLY FTO"SHIP <br /> III 24 HOUR -EMERGENCY CONTACT PERSON <br /> DAYS: NAr.S(LAST NAMw P:iS7) AND PHONE W/AREA CGDE i N_;.MTSE <br /> GARDELLA, STEPHEN `J. -SR. 209-368x1248 GARDEL <br /> COMPLETE THE FOLLOWING ,.:ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (XJ 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 41 <br /> t <br /> S. MANUFACTURER (IF APPROPRIATE): PERKINS YEAR)MFG: 1971 It _YUjf*iR_STACtTD7 1-9n----( ) UNKNOWN <br /> 0. CONTAINER CAPACITY: 10000 GALLONS ( ) UNKNOWN E. ODES THE CONTAINER STORE' t 1 01 WASTE (XI 02 PRODUCT <br /> F. DOES THE CCNTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL. ? (X) 01 YES ( ) 02 Nfl IF YES CHECK APPROPRIATE BOX(ES):. <br /> ( l 01 UNLEADED (X) 02 REGULAR ( 1 .03 PREMIUM E l 04 DIESEL ( f 45 > ASTE OIL ( 1- 06-OTHER <br /> 3 <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1/4 ( 1 GAUGE (X) INCHES' [ 1 CM I l UNKNOWN <br /> 8 ( l <br /> 01 VAULTED (LOCATED INANUNDERGROUND VAULT) (.X) 02 NON-VAULTED ( ) 03 UNKNOWN __ r <br /> C. t ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED.;, ( 1 03 .LINED:: ,- - <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL:', ( 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( l 06 ALUMINUM ( l 07 STEEL CLAD ( 1 08 BRONZE ( ) 09 COMPOSITE •( ) 10 NON-METALLIC <br /> t ) 12 UNKNOWN { l 13 OTHER: <br /> MSC04-070185 (10/181&5} PAGE 1 <br />