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NUMBER 00000002204001 <br /> APPLICATION FOR PERMIT TO 0 ERATE UNDERGROUND STORAGE TANK <br /> ( 01 NEW PERMIT ( ) 05 RENEWED PERMIT l ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (170 FEE1 <br /> ( ) 02 LONJ) ONAL PERMIT ( 1 06 ME <br /> PERMIT l ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDZVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> JOHN DWYER ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESSCITY STATE ZIP <br /> P.O. BOX 223266 CARMEL CA 93922 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> HANSEL & ORTMAN DON MANN <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 715 N. HUNTER STREET PARK STREETS <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95202 <br /> MAILING ADDRESS CITYSTATE ZIP <br /> P.O. BOX 1291 STOCKTON CA 95201 <br /> PHONE W/AREA CODE TYPEOF BUSINESS <br /> 209-465-5875 ( ) 01 GASOLINE STATION (X) 02 OTHER AUTO DEALERSHIP <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> I <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 /> BRUCE VAN SLYKE 209-465-5875 BRUCE VAN SLYKE 209-464-2632 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TAMC ( ) 04 OTHER: CONTAINER NUMBER R1-HO <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: GALLONS (X) UNKNOWN E. DOES THE CONTAINER STORE: (X) 01 WASTE ( ) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (XI 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> f 1 01 UNLEADED ( ) 02 REGULAR ( l 03 PREMIUM ( ) 04 DIESEL (X) OS WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES l ) CM (X) UNKNOWN <br /> B. f 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. l ) 01 DOUBLE WALLED ( ] 02 SINGLE WALLED ( 1 03 LINED <br /> O. ( ) 01 CARBON STEEL ( 1 02 STAINLESS STEEL t 1 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM 1 1 07 STEEL CLAD f 1 08 BRONZE ( 1 09 COMPOSITE ( ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />