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STATE ID NUMBER 00000004373002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 01 NEW PERMIT ( ) 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 /> NLMEECC'PPCPATION.INDIVIDUAL OR PUBLIC .AGENCY) PUBLIC AGENCY ONLY <br /> 'STEPHENS MARINEr INC. ( 1 <br /> 01 FED f 1 02 SLATE [ ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 345 N. YOSEMITE STEET STOCKTON CA 95203 <br /> II FACILITY <br /> F,ACILZTY NAME DEALER:'FOREMAN/SUPERVISOR <br /> STEPHENS ANCHORAGE RICK HAGERMAN <br /> ST=EET ADDRESS NEAREST CROSS STREET <br /> 4950 W. BROOKSIDE ROAD <br /> CITY' COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95207 <br /> MAILING ADDRESS CITY STATE ZIP <br /> P.D. BOX 670 STOCKTON CA 95201 <br /> PHONE W/AP.EA CODE TYPE OF BUSINESS <br /> 209-466-8691 ( ) 01 GASOLINE STATION (X) 02 OTHER MARINA <br /> NUMBER OF CONTAINERS ::� RU�FAL4RE�ASONLY TOSJNSHIP RANGE SECTION <br /> 4 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE :.i/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> RICK HAGERMAN 209-951-4144 S tC . 209-qq*zazz;4- <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> F_. <br /> A. (X) 01 TANK ( ) 04 OTHER: ]CONTAINER NUMBER 3 <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 4000 GALLONS i ) UNKNOWN JE. 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 /> ( 1 01 UNLEADED (X) 02 REGULAR ( 1 03 PREMIUM ( l 04 DIESEL l 1 05 WASTE OIL C l 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: [ ) GAUGE ( ) INCHES f ) CM (X) UNKNCWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( ) 03 LINED <br /> 01 CARBON STEEL t ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE f 1 05 CONCRETE <br /> ( ) 06 ALUMINUM CX) 07 STEEL CLAD f ) 08 BRONZE f 1 09 COMPOSITE f ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE I <br />