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STATE ID NUMBER 00000051616003 <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 /> t ) 02 CONDITIONAL PERMIT [ ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COP,POR TION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> J [3-tiEOR ( ) 01 FED t ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS y C}�� CITY STATE ZIP <br /> "�l-MERIElE GR. RB,. �Q &GO+— (.Q CA OS249--77 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREM N/SUPERVISOR <br /> JAMES HeM <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 2057 S. EL DORADO DELHI ST. <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95206 <br /> MAILING ADDRESS CITY STATE ZIP <br /> P.00 Q SGCK�GW. CA p s <br /> PHONE W/AREA CODE TYPE OFBUSINESS <br /> 209-?4iE4348'�$ Zfp (X) 01 GASOLINE STATION ( ) 02 OTHER <br /> INLiMBER OF CONTAINERS TR <br /> RAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAM AME FIR T) PHONE"Ir S A CODE_ NIGHTS: NAME(LAST NAME FIRST) AND PMONE�`AREA CODE <br /> ,,1����y/('. QQOO--'5 �-����,((//YY Z SAME -9¢�-�vf <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( l 04 OTHER: CONTAINER NUMBER 2 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS ( } UNKNOWN E. 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 /> A. THICKNESS OF PRIMARY CONTAINMENT: ( 1 GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ) 02 NON-VAULTED W7-03 UNKNOWN <br /> C. t ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( ) 03 LINED <br /> D. ( ) 01 CARBON STEEL (X) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> { ) 06 ALUMINUM ( l 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( 1 10 NON-METALLIC <br /> i l 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE i <br />