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—STATE ID NUMBER 00000039528003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> f'I 01 NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> �) 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> N.AMEICOPPORATTON.INOIVIPUAL OR-PUS IC AGE CY) PUBLIC AGENCY ONLY <br /> 01 FED ( ) 02 STATE l ) 03 LOCAL <br /> STFEET ADO FESS CITY STATE ZIP <br /> o r 4DS-AHGEkE9 CA <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> MOBIL SERVICE STATION JOHNNY GRIFFIN <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 75 EAST ALPINE EL DORADO <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95204 <br /> MAILING ADDRESS CITYSTATE ZIP <br /> 75 EAST ALPINE STOCKTON CA 95204 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-463-554 (X) 01 GASOLINE STATION [ ) 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 4 <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 /> GRIFFIN. JOHNY 209-463-5549 mj ==_ __._ — Y <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( l 04 OTHER: CONTAINER NUMBER 3 <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: 1973 C. YEAR INSTALLED 1973 ( 7 UNKNOWN <br /> D. CONTAINER CAPACITY: 5000 GALLONS ( l 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 /> ' ( ) 01 UNLEADED f ) 02 REGULAR 03 PREMIUM ( 104 DIESEL ( ) 05 WASTE OIL (X) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE 1 1 INCHES ( ) CM (X) UNKNOWN <br /> B. f ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. f ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( 1 02 STAINLESS STEEL f 1 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE 1 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ] 07 STEEL CLAD ( ) 08 BRONZE f ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> f ) 12 UNKNOWN ( 7 13 OTHER: <br /> KSC04-070185 (10/18/85) PAGE 1 <br />