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STATE 10 NUMBER 00000011295001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> �1 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 /> NAM.E(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CITY OF STOCKTON ( ) 01 FED ( ) 02 STATE _6V_03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 425 N. EL DORADO STOCKTON CA 95202 <br /> II FACILITY ' <br /> FACILITY <br /> -TWY MNAME Y • 11 ° 60 <br /> 0lyDEALER/FOREMAN/SUPERVISOR <br /> -04 <br /> COMPANY OFFICERS <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 550 E. HARDING WAY CALIFORNIA <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95204 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 550 E. HARDING WAY STOCKTON CA 95204 <br /> PHCNE W/AREA CODE TYPE OF BUSINESS <br /> 209-462-4093 ( ) 01 GASOLINE STATION (X) 02 OTHER FIRE STATION <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 1 N/A N/A N/A <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(L ST NAME FIRST) AND PHONE W/ARCA CODE NIGHTS: NAME(LAST NAME FIWST) AND PHONE W/AR[A COOK <br /> SAI* ��r`YG� S�GYS! SAME aa9 -yoe <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: C. YEAR INSTALLED 1967 f ) UNKNOWN <br /> D. CONTAINER CAPACITY: 550 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 BOX(ES): <br /> f ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION p <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE f ) INCHES ( l CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED L>_6 02 SINGLE WALLED ( ) 03 LINED <br /> D., ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( l 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE f ] 05 CONCRETE <br /> ( ) 06 ALUMINUM f 1 07 STEEL CLAD f l 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> MSC04-070185 (10/18/851 PAGE 1 <br />