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f- <br /> 7?44 To 3E RE4qove-0 <br /> I©/f S.? STATE ID NUMBER 00000009064001 <br /> APPLICATION FOR PERMITl_��HUUIT"OOUHLRATRATE UNDERGROUNrl STORAGE TANK <br /> ( ) 01 NEW PERMIT f ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED (W) 09 DELETE FROM FILE (NO FE <br /> ( 1 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT 08 MINOR CHANGE (NO SURCHARGE) <br /> [ OWNER <br /> VAME(CCPFOPATION.INDIVIDUAL OR PURL c AGE rvCv) PUBLIC AGENCY ONLY <br /> p g R G. {C E ( 1 01 FED ( ) 02 STATE ( 1 03 LOCAL <br /> '+TREET ADD-ESS <br /> .E 1103 CITY STATE ZIP °►f2 So <br /> 6 Rgn+T� qND Ct H�) o CA ssse6 <br /> I FACILITY <br /> LiTY <br /> NAME F'� ��O/1 C+ DEALER/FOPEMAN/SUPERVISOR �,�/ y�' y��/-' / <br /> ne.-. P wQQ, R (� J �5 nc nrniir�r........ ALO_oL k ( r0/C /C/� <br /> TP.EET ADDRESS NEAREST CROSS STREET -� <br /> .601 FRENCH CAMP TURNPIKE SOUTH LINCOLN ST. <br /> -TY COUNTY <br /> 10CKTON Zip <br /> SAN JOApUIN 95206 i <br /> AILING ADD---SS CITY <br /> / .1N STATE zip <br /> ( V % STOCKTON CA 95201 —� <br /> HON` W/AREA CC-E TYPE OF BUSINESS <br /> 204) q67— t& l q67— ( ) 01 GASOLINE STATION (X) 02 OTHER <br /> jMBER OF CCNTAINEPS PUPAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 1 <br /> II 24 HOUR EMERGENCY CONTACT PERSON <br /> >1'S: NIME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> ,II'3T1�P*6G--8EF_ aep 464�9BB4"' AE9tl�9TAPffCF"FS�f� 4B9'�Si"4E'l2 <br /> 'IALcolr-, Fo2TdivEyor H67-rb► G N1ilLCo� ngFoRTdNE 95/ - /$Sy <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> V DESCRIPTION <br /> (XI 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 1 <br /> MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1972 ( ) UNKNOWN <br /> CONTAINER CAPACITY: 1000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( 1 01 WASTE (X) 02 PRODUCT <br /> DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? fX) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOXIEST: <br /> ( 1 <br /> 01 UNLEADED (X) 02 REGULAR ( 1 03 PREMIUM ( 1 04 DIESEL ( 1 05 WASTE OIL ( 1 06 OTHER <br /> CONTAINER CONSTRUCTION <br /> THICKNESS OF PRIMARY CONTAINMENT: t ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> ( ) <br /> 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( 1 03 LINED <br /> (XI 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE [ ) 05 CONCRETE <br /> ( )- 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> 04-070185 (10/18/85) <br /> PAGE 1 <br />