Laserfiche WebLink
Y, <br /> �✓ STATE ID NUMBER 00000036521001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) 01 NEW PERMIT f ) 05 RENEWED PERMIT 07 T -�' ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT f l 06 AMENDED PERMIT ( ) 0 CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> GOODWILL INDUSTRIES OF SAN JOA ( ) 01 FED ( l 02 STATE ( ! 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 129 SOUTH GRANT STOCKTON CA 95202 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> GOODWILL INDUSTRIES OF SAN JOA DARYL 0. DAVENPORT <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 129 SOUTH GRANT MARKET <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95202 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 129 SOUTH GRANT SAME CA 95202 <br /> PHONE W/AREA CODE TYPEOF BUSINESS <br /> 209-466-2311 ( ) O1 GASOLINE STATION (X) 02 OTHER REHABILITATION FACIL <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 2 <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 /> DARYL D. DAVENPORT 209-466-2311 OARYL 0. DAVENPORT 209-478-6225 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. 1X1 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1967 C. YEAR INSTALLED 1967 ( l UNKNOWN <br /> D. CONTAINER CAPACITY: 6000 GALLONS f 1 UNKNOWN E. DOES THE CONTAINER STORE: f ) 01 WASTE (X1 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (XI 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED (X1 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL l l 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 0.25 f 1 GAUGE (XI INCHES ( ) CM ( l UNKNOWN <br /> B. ( 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (XI 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( l 03 LINED <br /> D. (X) 01 CARBON STEEL f 1 02 STAINLESS STEEL ( l 03 FIBERGLASS f l 04 POLYVINYL CHLORIDE l ) 05 CONCRETE <br /> [ ) 06 ALUMINUM t 1 07 STEEL CLAD ( ) 08 BRONZE ( ] 09 COMPOSITE ( ) 10 NON-METALLIC <br /> f ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />