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1 STATE ID NUMBER 00000064661001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> %a-01 NEW PERMIT f ) 05 RENEWED PERMIT ( 07 TANK CLOSED /0 g ( 1 09 DELETE FROM FILE (NO FEE) <br /> ( 1 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION.INDIVIOUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CAL-TRANS ( ) 01 FED f 102 STATE f 1 03 LOCAL <br /> STREET ADDRESS CITY STATE IIP <br /> 1976 E. CHARTER WAY STOCKTON CA 95205 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> "amff-DrmE Di cc to ow'r eugil5 <br /> STOEET .ADDRESS NEAREST CROSS STREET <br /> 1976 E. CHARTER WAY CHRTR. NAY/B ST. <br /> CITY COUNTY IIP <br /> STOCKTON SAN JOAQUIN 95205 <br /> MAILING ADDRESSCITY STATE IIP <br /> P.O. BOX 2048 STOCKTON CA 95201 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-948-7246 ( 1 01 GASOLINE STATION (X) 02 OTHER MAINTENANCE STATION <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 2 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA COOK NIGHTS: NAME(L ST NAME FIRST) AND PHONE W/AREA CODE <br /> SWEETEN, GARY 209-948-3871 4*eK-iORRSOR / _36B.i55fi' <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 308 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1971 t#1 UNKNOWN <br /> D. CONTAINER CAPACITY: 275 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: (X) 01 WASTE f 1 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (.Xi 01 YES OC) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> l ) 01 UNLEADED f ) 02 REGULAR f l 03 PREMIUM ( ) 04 DIESEL ( 1 05 WASTE OIL fX) 06 OTHER -WBEHBw fiaxpz <br /> G <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES f 1 CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) 1 02 NON-VAULTED L.Y.L 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( 1 03 LINED <br /> D. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD 1 ] 08 BRONZE l 1 09 COMPOSITE ( ) 10 NON-METALLIC <br /> IX) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/16/85) PAGE 1 <br />