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Now, �mo STATE ID NUMBER 000000224951001 <br /> APPLICATION FOR PERMIT TO OPE ATE UNDERGROUND STORAGE TANK <br /> ( ) 01 NEW PERMIT ( ] 05 RENEWED PERMIT )' a�. 1 ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ] 02 CONDITIONAL PERMIT ( l 06 AMENDED PERMIT ) 08 MZNOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CO RATION. DIV OUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> AGR I ERS /. .syr//�1 fi? ire .fPrv��e ( ) 01 FED [ l 02 STATE C ) 03 LOCAL <br /> STFE=_T ADDRESS ��` �n �/A' $/�/ CI €� ,(/_/ —/ CAATE ZIP <br /> II FACILITY <br /> FACIL2T ' NAME ///JJ ..{/� � 1 <br /> /1e DEALER�— R�/F�O�RESMAAE ISO <br /> STREET ADDRESS ,o(y�c(_— F y/ �-� NEAREST CROSS STREET <br /> lG+�5-i:HID6ERGf1�T. , , , � <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95206 <br /> MAILING ADDRESS 76f ��Ya/j7! CITY !� .. STATE Zip S.1OE <br /> P�_�2� SCA 95231 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-982-5731 ( ) 01 GASOLINE STATION (X) 02 OTHER AERiRt"rkMti6AiOR� �/191f\'L QfAd Y' <br /> NUMBER OFTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODENIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> ia 209-982-5731 ECCLES, R.D. 209-477-2142 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. IX) 01 TANK ( ) 04 OTHER: CONTAINER`NYWiiA-L11 � <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( 1 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 01 UNLEADED (X) 02 REGULAR f 1 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f ) GAUGE ( 1 INCHES ( ) CM (X) UNKNOWN <br /> S. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. f ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED l ) 03 LINED <br /> 0. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL f 1 03 FIBERGLASS l ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM f ] 07 STEEL CLAD f ) 08 BRONZE ( 1 09 COMPOSITE l ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> `/ Napo <br />