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STATE ID NUMBER 00000019740001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> LLill-` <br /> X <br /> 01 NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( 7 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPOPATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> E.F.MITCH LER CO. ( ) 01 FED f ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS <br /> CTOITY STATE ZIP <br /> 400 S LINCOLN ST SCKTON CA 95203 <br /> II FACILITY <br /> FACILITY NAME <br /> E.F.MITCH LER CO DEALER/FOREMAN/SUPERVISOR <br /> S� <br /> STREET ADDRESS NEAREST CROSS S"'REFT <br /> 400 S. LINCOLN ST MIMSM"A.Tw <br /> G.1A5/F/�T6�J <br /> CITY <br /> COUNTY <br /> STOCKTON SAN JOAQUIN ZIP <br /> 95203 <br /> MAILING ADDRESLINCOLN <br /> CITY STATE ZIP <br /> 400 S. LINCOLN ST STOCKTON CA 95203 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-466-8941 [TYPE <br /> 01 GASOLINE STATION (X) 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 2 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAMECLAST NAME FIRST) AND PHONE W/AP.EA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> KLEIN. ROBERT 209-466-8941 KLEIN) ROBERT 209 Ws =___ aH• <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 /> S. MANUFACTURER (IF APPROPRIATE): MCCUTCHEN YEAR MFG: 1984 C. YEAR INSTALLED 1984 ( 1 UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( 1 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 /> (X) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: / (X) GAUGE k) INCHES 1 ) CM ( 1 UNKNOWN <br /> S. ( 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( 1 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( 7 03 LINED <br /> D. (X) 01 CARBON STEEL f 7 02 STAINLESS STEEL ( ) 03 FIBERGLASS f l 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM f 1 07 STEEL CLAD ( 1 08 BRONZE ( 1 09 COMPOSITE ( 1 10 NON-METALLIC <br /> ( ) 12 UNKNOWN f ) 13 OTHER: <br /> HSC04-070185 (10/18/851 <br /> PAGE 1 <br />