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STATE ID NUMBER 00000012149001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 01 NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> -4"o' 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPOPATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> COLLINS ELECTRICAL CO., INC. ( ) 01 FED ( ) 02 STATE f ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 611 W. FREMONT ST. STOCKTON CA 95203 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> COLLINS ELECTRICAL CO., INC. H.J.THOMPSON, PRESIDENT <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 611 W. FREMONT ST. EDISON STREET <br /> 11 <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95203 <br /> M41LINO ADDRESS CITYSTATE ZIP <br /> P.O. BOX 1609 STOCKTON CA 95201 <br /> PHONE W/APEA CODE TYPE OF BUSINESS <br /> 209-466-3691 ( 1 01 GASOLINE STATION (X) 02 OTHER ELECTRICAL CO. <br /> NJMSER 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 /> H. J. THOMPSON 209-466-3691 H.J. THOMPSON 209-466-3691 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK f ) 04 OTHER: CONTAINER NUMBER 1 Q q/ <br /> S. MANUFACTURER (IF APPROPRIATE): UNK YEAR MFG C. YEAR INSTALLED /7 76(X) UNKNOWN <br /> D. CONTAINER CAPACITY: 5000 GALLONS 1 1 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 ( 1 02 NO IF YES CHECK APPROPRIATE BOX(ES)- <br /> (X) 01 UNLEADED f ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL l ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f ) GAUGE ( ) INCHES f 1 CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) l ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. l ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED f ) 03 LINED <br /> 0. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( l 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> f ) 06 ALUMINUM ( ) 07 STEEL CLAD ( 1 08 BRONZE l l 09 COMPOSITE ( 1 10 NON-METALLIC <br /> fX) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />