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STATE ID NUMBER 00000032626001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 01 NEW PERMIT ( 7 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> f ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COP.PORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> JEFFERSON SCHOOL DISTRICT - ( ) 01 FED ( ) 02 STATE ( l 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 7500 LINNE RD. TRACY CA 95376 <br /> II FACILITY <br /> FACILITY NAME DEALER/POREMAN/SUPERVISOR <br /> JEFFERSON SCHOOL THOMAS HAWKINS <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 7500 LINNE RD. CHRISMAN RD. <br /> CITY COUNTY ZIP <br /> TRACY SAN JOAQUIN 95376 <br /> MAILING ADDRESS CITYSTATE ZIP <br /> 7500 LINNE RD. TRACY CA 95376 <br /> PHONE W/AREA CODE TYPEOF BUSINESS <br /> 209-835-3053 ( ) 01 GASOLINE STATION (X) 02 OTHER ELEMENTARY SCHOOL <br /> NUMBER OF CONTAINERS RURAL AREAS ONLYTOWNSHIP RANGE SECTION <br /> 2 3S 5E 11 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DANS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME((LAST NAME FIRST) AND PHONE W/AREA CODE <br /> DOOCET, NAR9tB 209-635-9762 DABlEY. HNNPiD 209-835-9762 <br /> ,Joke Davgd &4 ?_ Sr36*-/579 Jus )-�e DavTd a 9- f3,57-/s9 <br /> PLETE THE FOLLOWING ON A SEPARATE F&*M'--F-OR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( 1 04 OTHER: CONTAINER NUMBER 001 <br /> B. MANUFACTURER (IF APPROPRIATE): MODESTO WELDING YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 500 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: f ) 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 1 7 03 PREMIUM ( ) 04 DIESEL l 1 05 WASTE OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS Of PRIMARY CONTAINMENT: 10 (X) GAUGE f 1 INCHES ( ) CM ( 7 UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL l ) 02 STAINLESS STEEL ( 7 03 FIBERGLASS ( 7 04 POLYVINYL CHLORIDE ( l 05 CONCRETE <br /> ( 1 06 ALUMINUM ( 1 07 STEEL CLAD ( 1 08 BRONZE ( ) 09 COMPOSITE ( i 10 NON-METALLIC <br /> ( l 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />