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STATE ID NUMBER 00000065642001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> [ 1 <br /> 01 NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( 2 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> Imo. Ai -E�ifIL, C I( ) 01 FED t ) 02 STATE 1 1 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 11Tif.'YtAROItlfritAY ",;)i✓/t// v. i;/.%L� STOCKTON CA 95204 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> INLAND PAINT CO. LARRY L. WRAY <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 117 W. HARDING WAY PAC. AVE <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95204 <br /> MAILING ADDRESSCITY STATE ZIP <br /> P.O. BOX 42% STOCKTON CA 95204 <br /> PHONE W/AREA CODE TYPEOF BUSINESS <br /> 209-466-0375 ( ) 01 GASOLINE STATION (X) 02 OTHER PAINT STORE <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 1 <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 /> LARRY WRAY 209-466-0373 LEE CLUFF 209-477-0661 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. lX) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER it <br /> B. MANUFACTURER (IF APPROPRIATE): MODESTO WELDING YEAR MFG: 1%4 C. YEAR INSTALLED 1%4 1 1 UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES (XI 02 NO IF YES CHECK APPROPRIATE SOX(ES): <br /> ( 1 <br /> 01 UNLEADED f 1 02 REGULAR f l 03 PREMIUM ( 1 04 DIESEL ( 1 05 WASTE OIL 6o 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( l INCHES t ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 !UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED 1X1 02 SINGLE WALLED f 1 03 LINED <br /> 0. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL t 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE t ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 7 07 STEEL CLAD [ ) 08 BRONZE ( 1 09 COMPOSITE ( 7 10 NON-METALLIC <br /> 1 ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (05/05/86) PAGE 1 <br /> US,( ✓ <br />