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STATE ID NUMBER 00000031637002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> Tkf 01 NEW PERMIT 05 RENEWED PERMIT ( ) 07 TANK t02 CONCLOSED ) 09 DELETE FROM FILE (NO FEE) <br /> CONDITIONAL PERMIT f ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CITY OF STOCKTON f ) 01 FED ( l 02 STATE Am-a.03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 425 N. EL DORADO STREET STOCKTON CA 95202 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUP ERVISOR <br /> VAN BUSKIRK GOLF COU4SE Tom'� 1(J O <br /> STREET ADDRESS �/ ,/ _ NEAREST CROSS STREET <br /> µouG�cW-Ag2M(ic 1-p-YO / 6a,-;X on Ave, <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95206 <br /> MAILING ADDRESS CITY STATE IIP <br /> 425 N. EL DORADO 5T. ROOM 301 STOCKTON CA 95202 <br /> PHONE W/AREA CODE TYPEOF BUSINESS <br /> 209-462-0943 ( ) 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 NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> 209-462-0943 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 1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 550 GALLONS f ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X1 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( l 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( 1 05 WASTE OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( 1 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL f ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE f 1 05 CONCRETE <br /> f ) 06 ALUMINUM f ) 07 STEEL CLAD [ ) 08 BRONZE f 1 09 COMPOSITE ( 1 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />