Laserfiche WebLink
STATE ID NUMBER 00000060123001 <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 />l 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 />mue sat .( ) 01 FED ( ) 02 STATE ( l 03 LOCAL <br />STREET ADDRESSCITY�� ATE_ _` ZIz <br />II FACILITY <br />III 24 HOUR EMERGENCY CONTACT PERSON <br />GAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br />898-�0C 00?(i g -��q SAME <br />rilvb, <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. <br />(X) 01 TANK ( ) 04 OTHER= <br />( ) GAUGE (X) INCHES ( <br />) CM ( ) UNKNOWN <br />FACILITY NAME L/+I� ( <br />/ � <br />MANUFACTURER (IF APPROPRIATE): MODERN <br />DEALER/FOREMAN/SUPERVISOR <br />YEAR MFG: <br />� � <br />D. <br />CONTAINER CAPACITY: 6000 GALLONS ( <br />STREET ADDRESS <br />CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br />NEARESTcCROSS STREET <br />1901 S. EL DORADO <br />FUEL OR WASTE OIL ? (X) <br />PREMIUM t ) 04 DIESEL <br />01 YES ( l 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br />( l 05 WASTE OIL ( l 06 OTHER <br />STH <br />CITY <br />COUNTY <br />ZIP <br />STOCKTON <br />SAN JOAQUIN <br />95206 <br />MAILING ADDRESS <br />CITY <br />STATE <br />ZIP <br />1901 S. EL DORADO <br />STOCKTON <br />TX <br />95206 <br />PHONE W/AREA CDE <br />TYPEOF <br />BUSINESS <br />B�CA�- 4elD.- ��9Q` <br />(X) O1 <br />GASOLINE STATION ( ) 02 OTHER <br />NUMBER OF CONTAINERS <br />RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br />III 24 HOUR EMERGENCY CONTACT PERSON <br />GAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br />898-�0C 00?(i g -��q SAME <br />rilvb, <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. <br />(X) 01 TANK ( ) 04 OTHER= <br />( ) GAUGE (X) INCHES ( <br />) CM ( ) UNKNOWN <br />CONTAINER NUMBER 1 <br />B. <br />MANUFACTURER (IF APPROPRIATE): MODERN <br />WELDING <br />YEAR MFG: <br />C. YEAR INSTALLED 177 1Wl UNKNOWN <br />D. <br />CONTAINER CAPACITY: 6000 GALLONS ( <br />) UNKNOWN <br />JE. DOES THE <br />CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br />F. <br />DOES THE CONTAINER STORE MOTOR VEHICLE <br />( l 01 UNLEADED i J 02 REGULAR ('+ 03 <br />FUEL OR WASTE OIL ? (X) <br />PREMIUM t ) 04 DIESEL <br />01 YES ( l 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br />( l 05 WASTE OIL ( l 06 OTHER <br />V CONTAINER CONSTRUCTION <br />A. <br />THICKNESS OF PRIMARY CONTAINMENT: 1/4 <br />( ) GAUGE (X) INCHES ( <br />) CM ( ) UNKNOWN <br />B. <br />( ).01 <br />VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON -VAULTED ( <br />) 03 UNKNOWN <br />C. <br />( ) <br />01 <br />DOUBLE WALLED (X) 02 SINGLE WALLED ( <br />l 03 LINED <br />D. <br />(X) <br />( ) <br />01 <br />) <br />12 <br />CARBON STEEL ( ) 02 STAINLESS STEEL ( <br />06 ALUMINUM ( ) 07 STEEL CLAD ( J 08 <br />UNKNOWN ( ) 13 OTHER: <br />) 03 FIBERGLASS ( ) 04 <br />BRONZE ( ) 09 COMPOSITE <br />POLYVINYL CHLORIDE ( ) 05 CONCRETE <br />( ) 10 NON-METALLIC <br />HSC04-070185 (10/18/85) <br />PAGE 1 <br />