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STATE ID NUMBER 0000001AGW 07 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) 01 NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAMEICOPPORATION,IyDDIVIDDUA©PUBLIC AGENCY) PUBLIC AGENCY ONLY02 <br /> ���w ( ) 01 FED ( l 02 STATE ( l 03LOCAL <br /> STREET ADDRESS CITY STATE ZIP 7 <br /> -14 9 3-GQU9T*-4Vdlf / �D $ fieW <br /> II FACILITY <br /> FACII TY NAM= DEALER/FOREMAN/SUPERVISOR <br /> Sim Sea <br /> lgewSPmemos <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1403 COUNTY CLUB PERSHING <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95204 <br /> MAILING ADDRESS CITY FCA <br /> ATE ZIP <br /> 1403 COUNTY CLUB STOCKTON 95204 <br /> PHONE W/AP.EA CODE TYPE OF BUSINESS <br /> 209-A43-C;4& (X) 01 GASOLINE STATION ( l 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY .TOWNSHIP RANGE SECTION <br /> x <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> R98fX=29ftttlP6 209- Z?��'2 'j'±/we 209-t3--3;ygr Z7 <br /> �MPLE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> YV- <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 2 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG:1976 C. YEAR INSTALLED 1976 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS ( ) 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 /> (X) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( l 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN.UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. ( l 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( A 05 CONCRETE <br /> ( ) 06 ALUMINUM (X) 07 STEEL CLAD ( ) 08 BRONZE (, ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />