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0 <br /> STATE ID NUMBER 00000001922001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> t ) 01 NEW PERMIT ( l 05 RENEWED PERMIT ( ) 07 TAMC CLOSED ( )- 09 DELETE FROM FILE (NO FEE) <br /> ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> DSS COMPANY ( ) 01 FED ( ) 02 STATE t ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 639 WEST CLAY STREET STOCKTON CAA 95206 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> OSS COMPANY BOYD GROVES <br /> STREET ADDRESS NEAR-EST "CROSS STREET <br /> 639 WEST CLAY STREET HARRISON <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95206 <br /> MAILING ADDRESS CITY STATE ZIP <br /> PO BOX Q STOCKTON CA 9520 6 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-948-0302 ( ) 01 GASOLINE STATION (X) 02 OTHER CONSTRUCTION <br /> NUMBER OF CONTAINERS RURAL AREAS ONLYTOWNSHIP RANGE SECTION <br /> 4 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: N.AME(L.AST NAME FIRST) AND PHONE W/APEA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> DUNN, PHILIP 209-948-0302 SILVA, DAN 209-466-9929 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV, DESCRIPTION <br /> A. :(X) 01 TANK t ) 04 OTHER CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 6000 GALLONS t )UNKNOWN E. DOES THE CONTAINER STORE: t l 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES f l 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED t ) 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: t l GAUGE t ) INCHES t ) CM (X) UNKNOWN <br /> r B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) 0 02 NON-VAULTED (*4 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( ) 03 LINED <br /> D. ( 01 CARBON STEEL ( ) 02 STAINLESS STEEL t ) 03 FIBERGLASS t ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE t ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> M 12 UNKNOWN ( ) 23 OTHER: <br /> HSC04-070185 '(10/18/85) PAGE 1 <br />