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✓�DUr <br /> STATE ID NUMBER 00000064662001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROU D STORAGE TANK <br /> I <br /> 01 NEW PERMIT ( 7 05 RENEWED PERMITS <br /> TANK CLOSED 5' /0 Y ( ) 09 DELETE FROM FILE (NO FEE) <br /> (/ ) 02 CONDITIONAL PERMIT [ ) 06 AMENDED PERMIT ( 7 8 MINOR CHANGE NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CAL TRANS ( 7 01 FED ( ) 02 STATE ( 7 03 LOCAL <br /> STREET ADDRESS CITY STAT! ZIP <br /> 1976 E. CHARTER WAY STOCKTON CA 95205 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> CCL <br /> STREET ADDRESS BOB SUMMERS <br /> F` NEAREST CROSS STREET <br /> 1604 'S' B ST. CHRTR. WAY/B ST. <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95206 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 1604 'S' B ST. STOCKTON CA 95206 <br /> PHONE W/AREA CODE TYPE OFBUSINESS <br /> 209-3G9-dCOi. 01 GASOLINE STATION (X) 02 OTHER MAINTENANCE STATION <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> J <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 /> BOB SLIMMERS 209-1SM8B.7�'�� SAME <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. EX) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 306 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> 0. CONTAINER CAPACITY: 500 GALLONS ( 1 UNKNOWN E. DOES THE CONTAINER STORE: l ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES (X) 02 NO IF YES CHECK APPROPRIATE BOX(ES)-- <br /> 01 <br /> OX(ES):O1 UNLEADED ( 1 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL (Y-!,06 OTHER KLQ(� <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f 1 GAUGE f 1 INCHES ( 7 CM (X) UNKNOWN <br /> B. ( I 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED 0M 03 UNKNOWN <br /> C. l 1 01 DOUBLE WALLED ( ] 02 SINGLE WALLED ( ) 03 LINED <br /> D. (&O1 CARBON STEEL ( 102 STAINLESS STEEL l ) 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 1 07 STEEL CLAD ( ) 08 BRONZE ( 1 09 COMPOSITE ( ) 10 HON-METALLIC <br /> (9P) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> vAw 4"d <br />