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i <br /> ` - STATE ID NUMBER <br /> APPLICATION FOR 'PtRMIT TO OPERATE UNDERGROURD STORAGE TANK <br /> D11 O1 NEW PERMIT l 1 05 RENEWED PERMIT (.4 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 1 02 CONDITIONAL PERMIT 1 1 06 AMENDED PERMIT 1 ) 08 MINOR CHANGE (N(1 SURCHARGE) <br /> I ) <br /> I OWNER <br /> NAME(COPPORATION.INCIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> ( ) O1 FED ( l 02 STATEal 3 LOCAL <br /> San O <br /> SrPEEi AC'fR ESS CITY STATE IIP <br /> 222 E. Weber Street ySi;nrktnn CA 95202 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOPEMEN'SUPERVISOR <br /> San Joaquin Co.- Motor Pool Leon Adamson <br /> STREET ACC=ESS NEAREST CROSS STREET <br /> 130 N. Hunter Channel <br /> CITY COUNTY IIP <br /> Stockton San Joaquin 9520 <br /> MAILING ADDRESS CITY STATE ZIP <br /> P.O. Box 1810 Stockton CA 95201 <br /> PHONE W'A�EA CODE TYPE CF BUSINESS <br /> ( ) 01 GASOLINE STATION (X1 02 OTHER Motor Pool <br /> NUMBER CF CONTAINEES PUPAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> 2 <br /> III . 4 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAr,EILAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> Adamson, Leon 209-9.44-3738 Adamson, Leon 344-5128 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. tX) 01 TANK f 1 02 OTHER: CONTAINER NUMBER `z <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (ht UNKNOWN <br /> 0. CONTAINER CAPACITY: GALLONS j�rl UNKNOWN E. DOES THE CONTAINER STORE: ( 1 01 WASTE _!i 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL 7-01 YES ( 1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> I ) 01 UNLEADED j* 02REGULAR ( ) 03 PREMIUM ( 1 04 DIESEL ( 1 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( 1 INCHES t ) CM _V UNKNOWN <br /> B. t ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULTI W02 NON-VAULTED t 1 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (fl 02 SINGLE WALLED 1 ) 03 LINED <br /> D. ( ) 01 CARBON STEEL l 1 02 STAINLESS STEEL f 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE l 1 05 CONCRETE <br /> 1 ) 06 ALUMINUM 1 ) 07 STEEL CLAD ( 1 08 BRONZE ( 1 09 COMPOSITE ( ) 10 NON-METALLIC <br /> l 12 UNKNOWII 1 ) 13 OTHER: <br /> HSC04-0:0185 PAGE 1 <br />