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STATE ID NUMBER 00000042017002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( l 01 NEW PERMIT ( ) 05 RENEWED PERMIT <br /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) C8 MING CHAN (NO SURCHARGE)) 09 DELETE FROM FILE (NO FEE) <br /> I OWNER <br /> NAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) <br /> CATHERINE OECLUE PUBLIC AGENCY ONLY <br /> ( <br /> STREET ADDRESS 1 01 FED f ) 02 STATE ( ) 03 LOCAL <br /> 507 ASPEN OITY STATE 9 <br /> STOCKTON CA 95252 <br /> 0b <br /> II FACILITY <br /> ffNAMECOMPANY DEALER/FOREMAN/SUPERVISOR <br /> HARLEY WARDSRT ST NEAREST CROSS STREET <br /> WILLOW <br /> COUNTY ZIP <br /> SAN JOAQUIN 95205 <br /> MAILING ADDRESS <br /> 1219 N. FILBERT ST CITY STATE zip <br /> STOCKTON CA 95205 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-464-4191 ( ) 01 GASOLINE STATION (X) 02 OTHER ROOFING COMPANY <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 /> WARD, HARLEY 209-464-4191 WARD, HARLEY 209-478-3879 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER R2 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED IX) UNKNOWN <br /> D. CONTAINER CAPACITY: 500 GALLONS ( l 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(ES1: <br /> ( ) 01 UNLEADED lX) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> D <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f ) GAUGE 1 ) INCHES f I CM (X) UNKNOWN <br /> B. ! ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED fX) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED [ ) 02 SINGLE WALLED ( 1 03 LINED <br /> D. [ ) 03 CARBON STEEL ( 102 STAINLESS STEEL ( ) 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( 1 06 ALUMINUM ( 1 07 STEEL CLAD ! ) 08 BRONZE f ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />