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`.. <br /> STATE ID M(J1BER 00000068206001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) <br /> 01 NEN PERMIT I ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 1 ) 02 CONDITIONAL PERMIT t ] 06 AMENDED PERMIT ( ) 08 MINOR MANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION.INOIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CALIF DEPT OF TRANSPORTATION ( ) O1 FED ( ) 02 STATE I ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 1120 N STREET SACRAMENTO CA 95814 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> EQUIP SHOP 10 <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1603 SO B ST <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95814 <br /> MAILING ADDRESS CITY STATE ZIP <br /> PO BOX 1632 STOCKTON CA 95207 <br /> PHONE W/ARCA CODE TYPE OF BUSINESS <br /> 000-000-0000 ( ) 01 GASOLINE STATION ( l 02 OTHER <br /> NUMBER OF CONTAINEPS RURAL AREAS ON'Y TOWNSMI,' RANGE SECTION <br /> 5 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAMEILAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 0000000001 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1954 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 5000 GALLONS ( ) 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 SOX(ES)l <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL ( 1 05 WASTE OIL l ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE t ) INCHES ( ) CM ( ) UNKNOW)) <br /> S. ( 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) l ) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. 1 ! 01 DOUBLE WALLED ( l 02 SINGLE WALLED l ) 03 LINED <br /> 0. (X) 01 CARBON STEEL t ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE t ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> f ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (07/03/87) PAGE 1 <br />