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�..i ld STATE ID NUMBER 00000031637001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> od—01 NEW PERMIT ( ) 05 RENEWED PERMIT (j1 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 1 02 CONDITIONAL PERMIT t 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAMC(CCRPORATICN,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CITY OF STOCKTON ( ) 01 FED ( ) 02 STATE L_12'0{ LOCAL <br /> STREET ADDRESS CTTY STATE IIP <br /> 425 N. EL DORADO STREET STOCKTON CA 95202 <br /> II FACILITY <br /> FACILITY NAME - - DEALER/FOREMAN/S PERVISO <br /> VAN BUSKIRK GOLF COURSES M � ' <br /> STREET ADDPESS � NEAREST CROSS STREET <br /> 4Gw&TQH_1'VENUE /7�' /POLLSCE <br /> CITY COUNTY IIP <br /> STOCKTON SAN JOAQUIN 95206 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 425 N. EL DORADO ST. ROOM 301 STOCKTON CA 95202 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-462-0943 ( 1 01 GASOLINE STATION (X) 02 OTHER PARK/GOLF COURSE <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 2 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NI OHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA COOC <br /> •" H�� 9-462-0943 209-464-8564 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 2 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1982 C. YEAR INSTALLED 1982 [ ) UNKNOWN <br /> 0. CONTAINER CAPACITY: 1000 GALLONS ( I UNKNOWN E. DOES THE CONTAINER STORE: ( 101 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(ESI: <br /> f ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL ( ) 05 WASTE OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( 1 GAUGE f ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) OE NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED f ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( l 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( 1 08 BRONZE ( ] 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> KSC04-070185 (10/18/85) PAGE 1 <br />