Laserfiche WebLink
• STATE ID NUMBER 00000014332005 <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 ( l 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPORATION INDIVIDU L OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> SH*RBeb,-i14C ( J 01 FED ( l 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS �© CITY ST.� ZIP <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN SUPERVISOR <br /> COUNW CLUB SERVICE GOB PHittFP9�jt4(6 f& Ll <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1403 COUNT' CLUB PERSHING <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/AP.EA CODE TYPE OF BUSINESS <br /> 209-943-0748 (X1 01 GASOLINE STATION ( l 02 OTHER <br /> NUMBER OFF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> A <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: N.AME(LAST NAME FIRST) AND PHONE W//AREA CODE NIGHTS: <br /> NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> 209-%+-3-mG'��?�!`C� l 209-�9-3-1 =� Z <br /> �Yl1RP`CETHE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1978 C. YEAR INSTALLED 1978 ( } UNKNOWN <br /> D. CONTAINER CAPACITY: 3000 GALLONS f l UNKNOWN E. DOES THE CONTAINER STORE: (X) 01 WASTE ( ) 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 ( ) 03 PREMIUM ( ) 04 DIESEL (X) 05 WASTE OIL ( l 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 ( l 03 LINED <br /> D. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( l 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM (X) 07 STEEL CLAD ( } 08 BRONZE ( l 09 COMPOSITE ( l 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />