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STATE ID NUMBER 00000001489001 <br /> APPLICATION FOR PERMIT TO OPER TE UNDERGROUND STORAGE TANK <br /> ( 1 01 NEW PERMIT ( 1 O5 RENEWED PERMIT C{ 07 TAW SED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CO <br /> NDITIONALL PERMIT ( ) 06 AMENDED PERMIT R CH (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATICN.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> POLAR WATER CO. INC. ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 1029 W. DDRESST 3T. STOCKTON CA 95203 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> POLAR WATER CO INC. ROBERT MILOSLAVICH JR. ROBE�� <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1029 W. FREMONT ST. SAN JOSE ST. <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95203 <br /> MAILING ADDRESS - CITY STATE ZIP <br /> 1029 W. FREMONT ST. STOCKTON CA 95203 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-466-6766 ( ) 01 GASOLINE STATION (X) 02 OTHER BOTTLED WATER CO. <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> C ' <br /> 1 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PMONE W/AREA CODE NIGH T3: NAME(IAST NAME FIRST) AND PHONE W/ARlA CODE <br /> MILOSLAVICH, ROST. 209-462-3629 SAME SAM-E - <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK f 1 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 550 GALLONS f ) UNKNOWN JE. DOES THE CONTAINER STORE: f l 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES fX) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( 1 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( 1 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: l ) GAUGE f ) INCHES ( 1 CM (X) UNKNOWN <br /> B. l ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. f 1 01 DOUBLE WALLED ( 1 02 SINGLE WALLED ( ) 03 LINED <br /> 0. (X) 01 CARBON STEEL I ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( 7 05 CONCRETE <br /> f ) 06 ALUMINUM [ ) 07 STEEL CLAD ( ) 08 BRONZE [ 1 09 COMPOSITE ( 1 10 NON-METALLIC <br /> l 1 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />