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I <br /> " STATE IO NUMBER 00000036521002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> l 1 <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT t�pL TAMc c�����oo �'S ( ) 09 DELETE FROM FILE (NO FEE) <br /> 1 l 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT (('Tli ;41lER'CR'A7GE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> GOODWILL INDUSTRIES OF SAN JOA ( ] 01 FED f ) 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 D. DAVENPORT <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 129 SOUTH GRANT MARKET <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95202 <br /> M>LLING ADDRESS CITY STATE2IR <br /> 129 SOUTH GRANT SAME CA 95202 <br /> PHONE W/AREA CODE TYPEOF BUSINESS <br /> 209-466-2311 ( ) 01 GASOLINE STATION (X) 02 OTHER REHABILITATION FACIL <br /> NUMBER CF 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 DARYL 0. DAVENPORT 209-478-6225 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 2 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1967 C. YEAR INSTALLED 1967 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 6000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: [ ) 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 /> f ) 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL l ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAIWIENT: 0.25 ( ) GAUGE (X) INCHES ( ) CM [ ) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. l ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED l ) 03 LINED <br /> D. (X) 01 CARBON STEEL l ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( l 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD f ) 08 BRONZE ( 109 COMPOSITE ( ) 10 NON-METALLIC <br /> ( 1 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> v <br />