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STATE ID NUMBER 00000013422002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> K) 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> f 1 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> z <br /> I OWNER <br /> NAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) <br /> PUBLIC AGENCY ONLY <br /> 01 FED ( 1 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS /� y/ <br /> s3 w-gNfi P, Q� Sg68 C TY ®MCR I�/L CSC CARTE ZIP <br /> 046E1. <br /> II FACILITY <br /> FACILITY NAME .. DEALER/FOREMAN/SUPERVISOR <br /> M ¢eKL�So2� <br /> STREET ADDPESS NEAREST CROSS STREW <br /> 2929 SOUTH HIGHWAY 99 La otKif <br /> CITY <br /> COUNTY <br /> STOCKTON ZIP <br /> SAN JOAQUIN 95205 <br /> MAILING ADDRESS CITY STATE IIP <br /> 2929 SOUTH HIGHWAY 99 STOCKTON CA 95205 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-gt. &5e.:- ( ) 01 GASOLINE STATION (X) 02 OTHER TRUCK TERMINAL <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE <br /> 2 SECTION <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 /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. fX) 01 TANK ( ) 04 OTHER) CONTAINER NUMBER 1-D <br /> B. MANUFACTURER (IF APPROPRIATE): ?????????????????????????????? YEAR MFG: ???? C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( 1 O1 WASTE (X1 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 /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM (XI 04 DIESEL ( 1 05 WASTE OIL f 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE f l INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED X) 02 SINGLE WALLED f ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE f ) 09 COMPOSITE [ 1 10 NON-METALLIC <br /> f 1 12 UNKNOWN ( ) 13 OTHER: <br /> NSC04-070185 (10/18/85) <br /> PAGE 1 <br />