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`/ 'Uo "TATE I0 NUMBER 00000039528004 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> (YJ <br /> 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 /> NAME(COP POPATION,IND IVIDUA OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> A(, l ) 01 FED f ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY 57.47E ZIP <br /> ET- 7"" CA AGB�T <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> MOBIL SERVICE STATION JOHNNY GRIFFIN <br /> gTPEET AODRESS NEAREST CROSS STREET <br /> 75 EAST ALPINE EL DORADO <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95204 <br /> M4ILING ADDRESS CITY STATE 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 FIRSTI AND PHONE W/AREA CODE <br /> GRIFFIN, JOHNY 209-463-5549 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. fX) Ol TANK ( ) 04 OTHER: CONTAINER NUMBER 4 <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: 1956 C. YEAR INSTALLED 1956 ( ) UNKNOWN <br /> 0. CONTAINER CAPACITY: 285 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: (X) 01 WASTE f ] 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 ) <br /> 01 UNLEADED f ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL (X) 05 WASTE OIL ( l 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (Xl 02 SINGLE WALLED ( ] 03 LINED <br /> D. (X) 01 CARBON STEEL ( 1 02 STAINLESS STEEL ( ) 03 FIBERGLASS f l 04 POLYVINYL CHLORIDE ( l 05 CONCRETE <br /> ( 1 06 ALUMINUM ( 1 07 STEEL CLAD ( ) OB BRONZE ( ) 09 COMPOSITE f ) 10 NON-METALLIC <br /> f ) 12 UNKNOWN ( 1 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> L/ �/ <br />