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� STATE ID NUMBER 0000047.4iiI&W <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br />` 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO 'FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPOP.ATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> m ( ) 01 FED ( 1 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS ?n �© CITY" STATE Z 4 <br /> om— <br /> I(/� <br /> II FACILITY <br /> FACILITY NAME II_ DEALER/FOREMAN/SUPERVISOR <br /> EC!i j Y\,x c- Sbor Bos-P utt <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1403 COUNTY CLUB PERSH <br /> INS <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95204 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 1403 COUNTY CLUB STOCKTON CA 95204 <br /> PHONE W/AREA CODE TYPEOF BUSINESS <br /> 209-943-0748 (X) O1 GASOLINE STATION ( l 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 9 -- <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: N.AME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> .ReBERT PHILLIPS 209-9 416f r7—Ztp Z 209 9;1 3;§=-- C� <br /> BETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( 1 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1976 C. YEAR INSTALLED 1976 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS t ) UNKNOWN JE. DOES THE CONTAINER STORE: ( ) 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 /> ( ) 01 UNLEADED ( ) 02 REGULAR (X) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> 0 <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCH€S ( ) CM (X) UNKNOWN <br /> B. ( l 01 VAULTED (LOCATED,IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS [ ) 04 POLYVINYL CHLORIDE ( l 05 CONCRETE <br /> 1 06 ALUMINUM (X) 07 STEEL CLAD t ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> t l 12 UNKNOWN ( l 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />