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To re R-"osL oje,�O� <br /> (/ STATE ID NUMBER 00000007014002 <br /> APPLICATION FOR PERMIT TO OPERATE UND RGROUND STORAGE TANK <br /> ( ) <br /> 01 NEW PERMIT f 1 05 RENEWED PERMIT (A Qj.�`"� � ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPORATION,ZNDZVIDUAL OR PUB C AOENCY.L - ,( PUBLIC AGENCY ONLY <br /> TILLIE LEWIS FOODS, DIVISION Or ( (p 17�D`�Prc4acfs &Y-P, ( ) 01 FED ( ) 02 STATE f 1 03 LOCAL <br /> STREET ADDRESS CITY STATE 22P <br /> 1405 S. FRESNO AVENUE STOCKTON CA 95206 <br /> II FACILITY <br /> FACILITY NAME ® (A.� DEALER/FOREMAN/SUPE ER SOR <br /> C�en Foo Prad '�s (,oc�p- <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1405 S. FRESNO AVENUE NAVY DRIVE <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95206 <br /> MAILING ADDRESS CITYSTATE ZIP <br /> P.O. DRAWER J STOCKTON CA 95201 -30) 3 <br /> PHONE W/AREA CODE TYPEOF BUSINESS " i <br /> 209-946 L)6 ( ) 01 GASOLINE STATION (X) 02 OTHER FOOD Pt:IIFF RVC.CSSI vts <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 CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA COD <br /> AtiBERSBfh(—DCMRtB 209-946-432t-c f-1 I ANDERSON,-DONT 209946-4'SI£ <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): UNKNOWN YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( 1 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 /> ( 1 <br /> 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL l ) 05 WASTE OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE f 1 INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( l 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM f ) 07 STEEL CLAD ( l 08 BRONZE ( 1 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( 1 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> 1.r <br />