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. • STATE ID NUMBER 00000066248001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE` O <br /> DELETE FROM FILE (NO FEE) <br /> j O1 NEW PERMIT ( ) 05 RENEWED PERMIT ( 7 07 TANK CLOSED <br /> ( 1 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) OB MINOR CHANGE (NO SURCHARGE) <br /> I OWNER IC AGENCY ONLY <br /> NA ME(CORPORATION.INDIV ID UAL OR PUBLIC AGENCY) <br /> O1 FED ( ) 02 STATE (Ar.)- 03 LOCAL <br /> SAN JOAQUIN COUNTY fH6tZC"M8 STATE ZIP",/ <br /> ��C�ITYP� <br /> CA 952yo iSTREET A RESST�,1� Z.L� Y, Prr <br /> II FACILITY Cr <br /> DEALER/FOREMAN/SUPERVISOR <br /> FACILITY NAME KEN BELCHER <br /> LOVELACE TRANSFER STATION NEAREST CROSS STREET <br /> STREET ADDRESS AIRPORT <br /> LOVELACE ROAD ZIP <br /> COUNTY 95231 <br /> CITY SAN JOAQUIN <br /> FRENCH CAMP STATE ZIP <br /> CITY CA 95201 <br /> MAILING ADDRESS STOCKTON <br /> P.O. BOX 1810 <br /> TYPE OF BUSINESS <br /> SolLdlvl0.s�¢. �O(S/ao <br /> PHONE W/AREA CODE ( 1 O1 GASOLINE STATION (X7 02 OTHER PdBkitrW�>� <br /> 209-982-5770 RANGE SECTION <br /> NUMBER OF CONTAINERS <br /> RURAL AREAS ONLY TOWNSHIP <br /> 1 <br /> III 24 HOUR EMERGENCY CONTACT PERSON NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> BELCHER, gen209-823-3602 <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> F8M HORTON/ Tom 209-944-2275 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> FKANUFACTURER <br /> IPTION <br /> CONTAINER NUMBER 1 <br /> A. 04 OTHER: <br /> YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> F APPROPRIATE):D. ITY: /OO(I GALLONS UNKNOW(') E. DOES THE CONTAINER STORE: 01 WASTE (AC) 02 PRODUCT <br /> O1 YES ( 1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ? <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL (Y1 <br /> ( ) O1 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM (.Y1 04 DIESEL ( ) 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION / <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES jJCS CM ( ) UNKNOWN <br /> g, ( ) O1 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (A;1'02 NON-VAULTED03 UNKNOWN <br /> C. ( ) O1 DCMLORII <br /> OUBLE WALLED lad 02 SINGLE WALLED ( 7 03 LINED <br /> 0 ( 1101 06BOOMALUSTTEEL (( )10025 STAINLESS STE1L08(BRO03 FIBERG AS�OMPOSITE 04 PO(L)V10YNON-METALLICL CHLORIDE ( ) 05 CONCRETE <br /> INUM <br /> EEL CLAD <br /> LAD <br /> (X) 12 UNKNOWN ( ) 13 OTHER: PAGE 7 <br /> HSC04-070185 (08/29/86) <br />