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0 <br /> STATE ID NUMBER 00000056885002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 01 NEW PERMIT t D 05 RENEWED PERMIT ( ) 07 TAMC CLOSED ( D 09 DELETE FROM FILE (NO FEE) <br /> 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER - <br /> NAME(COPPOPATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> GARY BURGIN t ) 01 FED ( ) 02 STATE ( D 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 2810 RICHLAND CT. STOCKTON CA 195207 <br /> II FACILITY <br /> FACILITY NAME DEALEP/FOREMAN/SUPERVISOP <br /> WATERLOO FOOD & FUEL GARY BURGIN <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 3032 E. WATERLOO RD. SUTRO <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95207 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 3032 E. WATERLOO RD. STOCKTON CA 95207 <br /> PMONE W/APER CODE TYPEOF BUSINESS <br /> 209-466-5816 (X) 01 GASOLINE STATION ( D 02 OTHER <br /> NUMBER OF CONTAINERS PUPAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: AME(LAST NAME FIRST) AN PHON W/AREA C E <br /> GARY BURGIN 209-478-8660 SAME - I I �" <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 2 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (.X)--UNKN,DWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS ( ) UNKNOWN JE. DOES THE CONTAINER STORE: ( D 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 ( D 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. t ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) t ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( l 02 SINGLE WALLED ( l 03 LINED <br /> D. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE t ) 05 CONCRETE <br /> ( ) 06 ALUMINUM t ) 07 STEEL CLAD ( ) 08 BRONZE ( D 09 COMPOSITE ( ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( D 13 OTHER: <br /> SC04-070185 (10/18/85) PAGE 1 <br />