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Wa STATE ID NUMBER 00000056885003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 01 NEW PERMIT ( D 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> t 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br />[ OWNER <br /> FAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> 3ARY BURGIN ( ) 01 FED ( ) 02 STATE ( D 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br />!810 RICHLAND CT. STOCKTON CA 95207 <br /> I FACILITY <br />°ACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> 4ATERL00 FOOD & FUEL GARY BURGIN <br />'TREET ADDRESS NEAREST CROSS STREET <br /> 3032 E. WATERLOO RD. SUTRO <br />:ZTY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95207 <br /> 1AILING ADDRESS CITY STATE 2YP <br /> 3032 E. WATERLOO R0. STOCKTON CA 95207 <br />>HONE W/AREA CODE TYPE OF BUSINESS <br /> t09-466-5816 (X) 01 GASOLINE STATION ( ) 02 OTHER <br /> FUNDER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP N <br /> 3 IRNGE <br /> II 24 HOUR EMERGENCY CONTACT PERSON <br />)AYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AVO PHO E W/AREA C OE <br />''ARY BURGIN 209-478-8660 SAME - (pb <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH ONTAINER <br /> V DESCRIPTION <br /> (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 3 <br /> 3. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED kX) UNKNO�k <br />): CONTAINER CAPACITY: 10000 GALLONS ( D UNKNOWN JE. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( l 04 DIESEL ( ) 05 WASTE OIL ( D 06 OTHER <br /> CONTAINER CONSTRUCTION <br /> 1. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> 3. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED t ) 03 LINED <br />)'. ( ) 01 CARBON STEEL ( D 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE H ) 10 NON-METALLIC t <br /> (X) 12 UNKNOWN ( ) 13 OTHER: f <br />;C04-070185 (10/18/85) PAGE 1 <br />