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?% <br /> STATE ID NUMBER 00000017798001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( 01 NEW PERMIT ( l 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 1 ) 02 CONDITIONAL PERMIT ( l 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME ORPORATION,INDIVIDU.AL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> T BROS.- ( ) 01 FED ( l 02 STATE f ) 03 LOCAL <br /> STR ADDRESS CITY STATE ZIP <br /> 1 1 WEST- *�WAY STOCKTON CA 95206 <br /> II FA LITY <br /> FACILITYNAMvO —^ DEALER/FOREMAN/ UPERVISOR <br /> F(9t•I <br /> GGJJ'' �11 �rzvc<- tom f ltt5io = <br /> STREET ADDRESS NEAREST CROSS STREET <br /> ksLv&G:F cG rce�. l - INTERSTATE HWY 5 <br /> 7 t <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95206 <br /> MAILING ADDRESS CITY STATE ZIP <br /> P.O. BOX 8130 STOCKTON CA 95208 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-4tt-- &" Yqt- z1f ( ) 01 GASOLINE STATION (X) 02 OTHER FARM <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 3T <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: N.AME(LAST NAME FIRST) AND PHONE W/.AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> 209-466-60.00 <br /> lk'&f "�MPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( l 04 OTHER: CONTAINER NUMBS 1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG C. YEAR .INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: © GALLONS HH 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 ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> (X) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL f ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( l 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (4) 02 NON-VAULTED t-),) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( ) 03 LINED <br /> D. 04 01 CARBON STEEL ( 102 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE t ) 05 CONCRETE <br /> I-'( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE { ) 10 NON-METALLIC <br /> EXt 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />