Laserfiche WebLink
STATE IO NUMBER 00000060123003 <br />APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br />t)V <br />01 NEW PERMIT ( ) 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 />1 OWNER <br />NAME(CORPORATION INDIVIDUAL OR PUBLIC AGENCY) <br />(/ <br />PUBLIC AGENCY ONLY <br />DEALER/FOREMAN/SUPERVISOR <br />NUMBER 3 <br />STREET ADDRESS <br />t ) 01 FED ( ) 02 STATE <br />( ] 03 LOCAL <br />STREET ADDRESST O` <br />YEAR INSTALLED f97 HH UNKNOWN <br />STA <br />IIP <br />JE. DOES THE CONTAINER STORE: ( <br />5TH <br />F. <br />CITY <br />II FACILITY <br />FACILITY NAME <br />(/ <br />CONTAINMENT: 1/4 <br />DEALER/FOREMAN/SUPERVISOR <br />NUMBER 3 <br />STREET ADDRESS <br />MANUFACTURER (IF APPROPRIATE): MODERN WELDING <br />YEAR MFG:TC. <br />NEAR ST CROSSSTREET <br />YEAR INSTALLED f97 HH UNKNOWN <br />1901 S. EL DORADO <br />CONTAINER CAPACITY: 12000 GALLONS ( l UNKNOWN <br />JE. DOES THE CONTAINER STORE: ( <br />5TH <br />F. <br />CITY <br />IF YES CHECK APPROPRIATE BOX(ES): <br />( ) 06 OTHER <br />D. <br />COUNTY <br />01 <br />) <br />12 <br />ZIP <br />STOCKTON <br />) 03 FIBERGLASS ( ) 04 <br />BRONZE ( ) 09 COMPOSITE <br />POLYVINYL CHLORIDE ( l 05 CONCRETE <br />( ) 10 NON-METALLIC <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 CODE <br />TYPE OF <br />BUSINESS <br />(X) 01 <br />GASOLINE STATION ( 102 OTHER <br />vmmmw- <br />NUMBER OF CONTAINERSRURAL <br />AREAS ONLY <br />TOWNSHIP <br />RANGE <br />SECTION <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 />8@9- 999"004fi $� `� SAME W dL_Z._ <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. <br />(X) 01 TANK ( ) 04 OTHER: <br />CONTAINMENT: 1/4 <br />CONTAINER <br />NUMBER 3 <br />B. <br />MANUFACTURER (IF APPROPRIATE): MODERN WELDING <br />YEAR MFG:TC. <br />VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON -VAULTED ( <br />YEAR INSTALLED f97 HH UNKNOWN <br />D. <br />CONTAINER CAPACITY: 12000 GALLONS ( l UNKNOWN <br />JE. DOES THE CONTAINER STORE: ( <br />) 01 WASTE (X) 02 PRODUCT <br />F. <br />DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO <br />( ) 01 UNLEADED 1&),02 REGULAR (-X+ 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL <br />IF YES CHECK APPROPRIATE BOX(ES): <br />( ) 06 OTHER <br />V CONTAINER CONSTRUCTION <br />A. <br />THICKNESS OF PRIMARY <br />CONTAINMENT: 1/4 <br />(X) GAUGE ( ) INCHES ( <br />) CM ( ) UNKNOWN <br />B. <br />( ) <br />01 <br />VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON -VAULTED ( <br />) 03 UNKNOWN <br />C. <br />( ) <br />01 <br />DOUBLE WALLED <br />(X) 02 SINGLE WALLED t <br />l 03 LINED <br />D. <br />(X) <br />( <br />01 <br />) <br />12 <br />CARBON STEEL <br />06 ALUMINUM <br />UNKNOWN ( ) <br />( ) 02 STAINLESS STEEL ( <br />( ) 07 STEEL CLAD ( l 08 <br />13 OTHER: <br />) 03 FIBERGLASS ( ) 04 <br />BRONZE ( ) 09 COMPOSITE <br />POLYVINYL CHLORIDE ( l 05 CONCRETE <br />( ) 10 NON-METALLIC <br />HSC04-070185 (10/18/85) <br />N f� <br />PAGE 1 <br />