Laserfiche WebLink
` STATE ID NUMBER 00000 APPLICATION FOR FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> l 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NA*�E(COPPCPATICN,INDIVIDUAL OR PUBLIC AGENCY) _ PUBLIC AGENCY ONLY <br /> iNe <br /> . rhe S' OA Vex-,o rc! ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STPE-cT AODPESS CITY STATE ZIP <br /> II FACILITY <br /> FACILITY NAME DE.ALEP./FOREMAN/nSULPERVISOR <br /> THE STOCKTON RECORD L� Vkr", <br /> STREET T MARKET <br /> NEAREST CROSS_ Sy�E!'E <br /> 530 EAST MAP.Y.ET STREET <br /> CITY COUNTY Zip <br /> STOCKTON SAN JOAQUIN 95202 <br /> MAILING ADDRESS CITY STATE ZIP <br /> P.O. BOX 900 STOCKTON CA 95201 <br /> PHONE W/A.PE.A CODE TYPE OF BUSINESS <br /> 209-943-6397 ( ) 01 GASOLINE STATION (X) 02 OTHER NEWSPAPER <br /> NUMBEP OF CCNTAINEPS PUPAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LA.S7 NAME FIRST) AND PHONE W/APE.A CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> LOPEZ, L. 209-943-6397 SECURITY 209-943-1155 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 7431-574 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1956 C. YEAR INSTALLED 1956 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 2200 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES (X) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( 1 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) J.4'1'02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( l 03 LINED <br /> D. (X) 01 CARBON STEEL ( l 02 STAINLESS STEEL ( l 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( 1 09 COMPOSITE ( l 10 NON-METALLIC <br /> ( l 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />