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STATE I0 NUMBER <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( O1 NEW PERMIT 110 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 1 02 CONDITIONAL PERMIT l 1 06 AMENDED PERMIT 1 1 04 MINOR CHANGE '(NO SURCHARGE) <br /> I OWNER <br /> NAME(COP PORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> St. Mar 's High $CL1001 l l O1 FED 1 ) 02 STATE f 1 03 LOCAL <br /> STREET ADORESS CITY STATE ZIP <br /> 5648 N. E1 Dorado Stockton Calif. 95207 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMEN/SUPERVISOR <br /> St. Mary's High School Fr. John P. Fallon, Principal <br /> STREET <br /> AOL <br /> NEAREST CROSS STREET <br /> 5648 N. E1 E <br /> doCITY -_ _-. _ _--- _ OVNTY ZIP <br /> Stockton, San Joaquin 95207 <br /> MAILING ADDRESS CITY STATE ZIP <br /> P. O. Box 7247 Stockton, CA 95207 <br /> PHONE W%APEA CODE TYPE OF DUSINESS <br /> -(299) 957-3340 f ) 01 GASOLINE STATION (X) 02 OTHER <br /> NUMBER OF CONTAINERS PUPAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> one <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 COOK <br /> Bound, Joseph (209)- 957-3340 Smith, Michael (209)- 4652-5877 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( 1 02 OTHER: CONTAINER NUMBER UL# J166644 L <br /> B. MANUFACTURER (IF APPROPRIATE): Perkins Welding YEAR MFG: 85C. YEAR INSTALLED 1955 f 1 UNKNOWN <br /> D. CONTAINER CAPACITY: 550 GALLONS l ) UNKNOWN I E. DOES THE CONTAINER STORE: ( 1 01 WASTE lIQ 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 ( ); 02 REGULAR 1 ) 03 PREMIUM f l 04 DIESEL ( ) 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 10 GAUGE ( ) INCHES ( 1 CM f 1 UNKNOWN <br /> B. ( 1 01 VAULTED ILOCATED IN AN UNDERGROUND VAULT) l )0 02 NON-VAULTED ( ) 03 UNKNOWN surrounded by sand. <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED f 1 03 LINED <br /> D. (YJ 01 CARBON STEEL 1 ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM l 1 07 STEEL CLAD f 1 08 BRONZE l 1 09 COMPOSITE ( 1 10 NON-METALLIC <br /> ( ) 12 UNKNOWN f l 13 OTHER: <br /> HSC04-070185 PAGE 1 <br /> - 1 <br />