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STATE ID NUMBER <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> (A 01 NEW PERMIT l 105 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 1 ) 02 CONDITIONAL PERMIT l 1 06 AMENDED PERMIT ( ) 00 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) John T.Verner,Kathleen M. PUBLIC AGENCY ONLY <br /> Verner, Richard N.Stepkeri, ,Birdie F. Ramirez Ste ken, Edward R. ( 1 01 FED f ) 02 STATE ( l 03 LOCAL <br /> Se <br /> PYRE ACORlSS <br /> ( , CITY STATE LIP <br /> 2724 Pacific Ave. Stockton CA 95204 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOPEMEN/SUPERVISOP <br /> Don Blair Lumber Co. None SS TR <br /> STREET AOOPESS NEARlP CROOQ P `T <br /> 2001 E. Fremont ST. <br /> CITY Stockton, COUNTY San Joaquin 4CA <br /> IP 95205 <br /> MAILING ADDPESS Dick Stepken REalty CITY ZIP <br /> 2724 Pacific Ave. Stockton 95204 <br /> PHONE W/APEA CODE TYPE OF BUSINESS <br /> -209-466-4043 ( 1 01 GASOLINE STATION (V 02 OTHER <br /> iNVM.BG Of CONTAINER S RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 1 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/ARCA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> Stepken Richard -209 466-4043 Stepken, Richard -209- 477-7754 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (k) 01 TANK ( 1 02 OTHER: CONTAINER NUMBER <br /> B. MANUFACTURER (IF APPROPRIATE)= Unknown YEAR MFG: C. YEAR INSTALLED ICO UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) Ol HASTE KA 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? LKI 01 YES ( 102 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ()() 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL 1 ) 05 WASTE OIL l ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( 1 INCHES ( ) CM M) UNKNOWN <br /> B. ( 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) f ) 02 NON-VAULTED (76) 03 UNKNOWN <br /> C. l 1 01 DOUBLE WALLED 00 02 SINGLE WALLED l 1 03 LINED <br /> D. f ) 01 CARBON STEEL ( 1 02 STAINLESS STEEL ( 1 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE l ) 05 CONCRETE <br /> l 1 06 ALUMINUM l 1 07 STEEL CLAD l 1 08 BROt)ZE ( 1 09 COMPOSITE ( l 10 NON-METALLIC <br /> ( 7,1 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 PAGE 1 <br /> City Water and Sewer <br />