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STATE ID NUMBER 00000017798003 <br /> k <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> Woo <br /> 1PERMIT ( ) 05 RENEWED PERMIT 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 2 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) OS MIWOR CHANGE (NO SURCHARGEI <br /> I OWNER <br /> NAM OP.POP..ATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> H T BROS.- ( ) 01 FED ( ) 02 STATE ( l 03 LOCAL <br /> T <br /> STP.E; P.DDRESS ISTO:CKTON <br /> STATE ZIP <br /> 1 WEST eHf9fiBir WAY CA 95206 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> HBtT BRB3 <br /> STREET ADDRESS /' % NEAREST CROSS STREET <br /> S© � W� /{ � INTERSTATE HWY 5 <br /> CITY COUNTY '95206 <br /> IP <br /> STOCKTON SAN JOAQUIN <br /> MAILING ADDRESS CITY STATE PIP <br /> P.O. BOX 8130 S70CKTON CA 95208 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209- 8 CSG ( ) 01 GASOLINE STATION (X) 02 OTHER FARM <br /> NUMBER OF- CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> ,Yt <br /> i <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LA.ST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> DAVID—*--44G" 209-466-6000 <br /> 1 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 3 <br /> B. MANUFACTURER (IF APPRROPPRRIA��TE): YEAR MFG: C. YEAR INSTALLED. (X) UNKNOWN <br /> D. CONTAINER CAPACITY: !Vl2// GALLONS (-�9 UNKNOWN JE. DOES THE CONTAINER STORE: ( l 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 /> ( l 0.1 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( l 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) i 02 NON-VAULTED HH 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( ) 03 LINED <br /> D. "Y 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS i l 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> trr 12 UNKNOWN ( ) 13 OTHER: <br /> KSC04-070185 (10/18/85) PAGE 1 <br />