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STATE ID NUMBER 00000039509001 <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(CORPORATZON,INDIVIDUAL OR PUBLIC AGENCY) <br />PUBLIC AGENCY ONLY <br />MOBIL OIL CORPORATION <br />( l 01 FED t ) 02 STATE ( ) 03 LOCAL <br />STREET ADOPESSCITY <br />-3; w VAN r-kxv J <br />STATE <br />94SL4 <br />to .%.4Z <br />Cowr_ot% <br />�CA <br />;.IPP <br />II FACILITY <br />FACILITY NAME <br />NAME(LA.ST NAME FIRST) AND <br />DEALER/FOREMAN/SUPERVISOR <br />MOBIL SERVICE STATION <br />NIGHTS: NAME(LAST NAME <br />-3; w VAN r-kxv J <br />STREET ADDRESS <br />YEAR MFG: 1984 <br />NEAREST CROSS <br />STP.EET <br />1469 EAST HAMMER LANE <br />Lo(61 <br />WEST <br />WxmJ:row-i <br />CITY <br />DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO <br />(X) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL t <br />COUNTY <br />POLYVINYL CHLORIDE ( ) 05 CONCRETE <br />( ) 10 NON-METALLIC <br />IIP <br />STOCKTON <br />SAN JOAQUIN <br />95207 <br />MAILING ADDRESS <br />CITY <br />STATE <br />ZIP <br />1469 EAST HAMMER LANE <br />STOCKTON <br />CA <br />95207 <br />PHONE W/AREA CODE <br />TYPEOF BUSINESS <br />209-478-1522 <br />(X1 01 GASOLINE STATION ( l 02 OTHER <br />NUMBER OF CONTAINERS <br />RURAL AREAS ONLY <br />TOWNSHIP <br />RANGE <br />SECTION <br />4 <br />III 24 HOUR EMERGENCY CONTACT PERSON <br />DAYS: <br />NAME(LA.ST NAME FIRST) AND <br />PHONE W/AP.EA CODE <br />CONTAINER <br />NIGHTS: NAME(LAST NAME <br />FIRST) AND PHONE WiARE.A CODE <br />MANUFACTURER (IF APPROPRIATE): UNKNOWN <br />YEAR MFG: 1984 <br />40N °k%16-3LW-'WfA <br />YEAR INSTALLED 1984 ( ) UNKNOWN <br />D. <br />Lo(61 <br />N <br />WxmJ:row-i <br />F. <br />DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO <br />(X) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL t <br />IF YES CHECK APPROPRIATE BOX(ES): <br />) 06 OTHER <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. <br />(X) 01 TANK ( ) 04 OTHER- <br />) GAUGE ( ) INCHES ( <br />CONTAINER <br />NUMBER 1 <br />B. <br />MANUFACTURER (IF APPROPRIATE): UNKNOWN <br />YEAR MFG: 1984 <br />C. <br />YEAR INSTALLED 1984 ( ) UNKNOWN <br />D. <br />CONTAINER CAPACITY: 12000 GALLONS ( I UNKNOWN <br />E. DOES THE CONTAINER STORE: ( <br />l 01 WASTE (X) 02 PRODUCT <br />F. <br />DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO <br />(X) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL t <br />IF YES CHECK APPROPRIATE BOX(ES): <br />) 06 OTHER <br />V CONTAINER CONSTRUCTION <br />A. <br />THICKNESS OF PRIMARY CONTAINMENT: ( <br />) GAUGE ( ) INCHES ( <br />) CM (X) UNKNOWN <br />B. <br />( ) 01 <br />VAULTED (LOCATED IN AN UNDERGROUND VAULT) <br />(X) 02 NON -VAULTED ( <br />) 03 UNKNOWN <br />C. <br />( ) 01 <br />DOUBLE WALLED (X) 02 SINGLE WALLED ( ) <br />03 LINED <br />D. <br />( ) 01 <br />( ) <br />( ) 12 <br />CARBON STEEL ( ) 02 STAINLESS STEEL (X) 03 FIBERGLASS ( ) 04 <br />06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( l 09 COMPOSITE <br />UNKNOWN ( ) 13 OTHER: <br />POLYVINYL CHLORIDE ( ) 05 CONCRETE <br />( ) 10 NON-METALLIC <br />HSC04-070185 (10/18/85) <br />PAGE 1 <br />