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. , - 7o S� Z�rKoUE1�LL1 JERGROUND <br /> STATE I0 NUMBER 00000007014001 <br /> APPLICATION FOR PERMIT TO OPERATE STORAGE TANK <br /> ( ) 01 NEW PERMIT ( ) 05 RENEWED PERMIT (� 07TAM r-nesn ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPFOP ATION,INOIV IDUAI OR PV LIC AGENCY) PUBLIC AGENCY ONLY <br /> ' @d,�q,L� �LLL•RJr, ( ) 01 FED l 1 02 STATE ( ) 03 LOCAL <br /> STREET 4DDRESS CITY STATE ZIP <br /> 1405 S. FRESNO AVENUE STOCKTON CA 95206 <br /> II FACILITY <br /> FACILITY NAME eh ^ n A 'I ^O DEALER/FOREMAN/SUPER ISOR <br /> > ftttE-eeWis �eees d LR�J 1(rod Jl`J C ff�. l4RK�XMh(� <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1405 S. FRESNO AVENUE NAVY DRIVE <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95206- 3013 <br /> MAILING ADDRESS CITY STATE ZIP <br /> P.O. DRAWER J STOCKTON <br /> CA 95201 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-946-4336`/12'I' f ) 01 GASOLINE STATION (X) 02 OTHER FOOD Pk#N� R-oc-t5�3iA.J <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA COOK NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CgDE i <br /> ANBERSGNrOON7M-D 209-946-41IE"�CI:III �' 209-946-4mo-c;LTj ?-7 S'>' <br /> '— COMFLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK l ) 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 3000 GALLONS ( ) UNKNOWN I E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X1 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> (X) 01 UNLEADED ( ) 02 REGULAR ( 1 03 PREMIUM ( 1 04 DIESEL f ) 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES f 1 CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED l ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (XI 02 SINGLE WALLED [ ) 03 LINED <br /> D. 1X1 01 CARBON STEEL ( 1 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM f l 07 STEEL CLAD [ ) 08 BRONZE ( ) 09 COMPOSITE ( ) 30 NON-METALLIC <br /> ( 1 12 UNKNOWN ( ) 13 OTHER: <br /> MSC04-070185 (10/18/85) PAGE 1 <br />