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1\4� STAT 10 NUMBER 00000037905002 <br /> 1' 4(r7 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STOR GE TANK <br /> ( ) 01 NEW PERMIT f ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED [ 09 DELETE FROM FILE (NO FEE) <br /> f 1 02 CONDITIONAL PERMIT f ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARG l <br /> I OWNER <br /> NAME(COPPCRATION,lNDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> NOMELLIN CONSTRUCTION COMPANY ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESSCITY STATE ZIP <br /> 939 WEST CHARTER WEAY STOCKTON CA 95206 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> HOMELLINI CONSTRUCTION CO ROY C. GODFREY <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 939 W. CHARTER WAY STOCKTON STR. <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95206 <br /> MOILING ADDRESS CITYSTATE ZIP <br /> 939 W. CHARTER WAY STKN. CA 95206 <br /> PHONE W/APEA CODE TYPE OF BUSINESS <br /> 209-466-5086 ( ) 01 GASOLINE STATION (X) 02 OTHER CONSTRUCTION CO. <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 CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> GODFREY, ROY 209-466-5721 GOOFREY, ROY 209-462-3077 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) Ol TANK ( ) 04 OTHER: CONTAINER NUMBER 2 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 GALLONS ( 1 UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> f 1 <br /> 01 UNLEADED ( 1 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL ( ) 05 WASTE OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE l 1 INCHES ( ) CM (X) UNKNOWN <br /> B. ( l 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) 1 ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( 7 03 LINED <br /> D. ( ) 01 CARBON STEEL ( l 02 STAINLESS STEEL ( ) 03 FIBERGLASS l 1 04 POLYVINYL CHLORIDE l ] 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD f 1 08 BRONZE ( 1 09 COMPOSITE ( 1 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />