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%NO ��''°°"L� 1 V-04STATEID NUMBER 00000024872004 <br /> APPLICATION FOR PERMIT TO OPERA�UNDERGROUND STORAGE TANK <br /> �( .O1 NEN PERMIT ( 1 05 RENEWED PERMIT f -b7_T NK OS ( 1 09 DELETE FROM FILE (NO FEE) <br /> 1- ] 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( 8-MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION.INDIVIOUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> SAN JOAQUIN COUNTY MOSQUITO AS ( ) 01 FED ( ) 02 STATE fr 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 5503 SOUTH AIRPORT WAY STOCKTON CA 95206 <br /> II FACILITY <br /> FACILITY NAME DEALER FOR,EMMAN/SUPERVISOR <br /> SAN JOAQUIN COUNTY MOSQUITO AS F10 7 <br /> STREET ADDRESS NEAREST CPOSSREET <br /> 5503 SOUTH AIRPORT WAY FY Pd f <br /> CITY COUNTY ZZP <br /> STOCKTON SAN JOAQUIN 95206 <br /> MAILING ADDRESS CITY STATE IIP <br /> 5503 SOUTH AIRPORT WAY STOCKTON CA 95206 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-982-4675 ( ) 01 GASOLINE STATION (X) 02 OTHER MOSQUITO ABATEMENT <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> b <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 /> FIORI, JACK V. 209-982-4675 FIORI. JACK V. 209-368-9518 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( 7 04 OTHER: CONTAINER NUMBER Moe <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1976 ( ) UNKNOWN <br /> .loft <br /> D. CONTAINER CAPACITY: ALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (%) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( l 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> (X) 01 UNLEADED 1 ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( l 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( 1 INCHES ( ) CM (X) UNKNOWN <br /> B. 1 ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. t ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( 1 03 LINED <br /> D. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE f 1 05 CONCRETE <br /> l ) 06 ALUMINUM (X) 07 STEEL CLAD ( 1 08 BRONZE ( 1 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/851 PAGE 1 <br />