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STATE ID NUMBER 000000 6 02 <br /> yy APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 'A1 01 NEW PERMIT ( l 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CAL TRANS ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET .ADDRESS CITY STATE ZIP <br /> 1976 E. CHARTER WAY STOCKTON CA 95205 <br /> II FACILITY <br /> PACIIITY NAME DEALER/FOREMAN/SUPERVISOR <br /> BOB SUMMERS <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1604 'S' B ST. CHRTR. WAY/5 ST. <br /> CITY COUNTY IF <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 /> 209-364-6961 Q((r(-'/��tJ ( l 01 GASOLINE STATION (X) 02 OTHER MAINTENANCE STATION <br /> NUMBER OF CONTAINERS PUPAL 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 CODE <br /> BOB SUMMERS209-111'QBB7!t SAME 9' r � <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 306-B <br /> S. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 2 WK UNKNOWN <br /> D. CONTAINER CAPACITY: &P GALLONS WH 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 BOX(ES): <br /> (4) 01 UNLEADED ( 1 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL WH 06 OTHER HNKNOWN-- <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE 1 1 INCHES f 1 CM (X) UNKNOWN <br /> B. ( 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( 02 NON-VAULTED "1 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( ) 03 LINED <br /> D. ( ) 01 CARBON STEEL ( 1 02 STAINLESS STEEL ()Q-03 FIBERGLASS ( l 04 POLYVINYL CHLORIDE I ) 05 CONCRETE <br /> l ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 06-BRONZE ( 1 09 COMPOSITE ( ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> KSC04-070185 (10/18/85) PAGE 1 <br />