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STATE ID NUMBER 00000017798002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 01 NEW PERMIT t ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> Tt ) 02 CONDITIONAL PERMIT { ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME OP.POP.ATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> T EROS. ( ) 01 FED ( ) 02 STATE t ) 03 LOCAL <br /> STRE ADDRESS CITY STATE 719 <br /> 1 WEST CH2522FEPWAY STOCKTON ST 6 <br /> II FACILITY <br /> FACILITY NAME 1 �./ ��" DEALER/FOREMAN/SUPERVISOR <br /> STREET ADDRESS NEAREST CROSS STREET <br /> INTERSTATE HWY 5 <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95206 <br /> MAILING ADDRESS CITY =CTA' <br /> TE ' ZIP <br /> P.O. BOX 8130 STOCKTON. 95208 <br /> PHONE W/AREA CODE # TYPE OF BUSINESS <br /> 209-46fsE699{1 Q `�7 t ) 01 GASOLINE STATION (X) 02 OTHER FARM t <br /> ..rte.... <br /> NUMBER, OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> *f3 i <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 /> 209-466-6000 y7 5A -- 7o S <br /> ETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBS 2 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG <br /> C. <br /> YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: GALLONS i-Yr) 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 /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. f ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) V 02 NON—VAULTED F'X-Y 03 UNKNOWN <br /> C. ( l 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( ) 03 LINED <br /> D. f 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ) 06 ALUMINUM ( ) 07 STEEL CLAD ( l 08 BRONZE ( 1 09 COMPOSITE ( ) 10 NON—METALLIC <br /> W4 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />