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STATE ID NUMBER 00000021906002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> (�1 NEW PERMIT ( 1 05 RENEWED PERMIT f ) 07 TANK CLOSED f 1 09 DELETE FROM FILE 1110 FEE <br /> 02 CONDITIONAL PERMIT f l 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAMEtCOPPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> BILL RACKLEY ( } 01 FED t l 02 STATE (*03 LOCAL <br /> STPEET ADDRESS CITY STATE ZIP <br /> P.O. BOX 5128 STOCKTON CA 95205 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMANjSUP RVI OR <br /> BILL RACKLEY TRUCKING INC. irs I <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 3333 SO. HWY 99 CARPENTER <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95205 <br /> MAILINO ADDRESS CITY STATE ZIP <br /> 3333 SO. HWY 99 SAME CA 95205 <br /> PHONE W/AREA CODE =TYPE BUSINESS <br /> 209-948-8586 GASOLINE STATION (XI 02 OTHER <br /> NUMBER Or CONTAINERSRURAL .AREAS ONLY : TOWNSHIP RANGE SECTIQN <br /> 2 <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 /> BILL RACKLEY 209-948-8586 BILL RACKLEY 209-931-4982 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 2 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: /f ,, J-0 , GALLONS ( ) UNKNOWN E. DOESTHE CONTAINER STORE: ( ) 01 WASTE t } 02 PRODUCT <br /> F. DO S THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> 01 UNLEADED ( ) 02 REGULAR ( ] 03 PREMIUM ( ) 04 DIESEL f ) 05 WASTE OIL ( l 06 OTHER <br /> V CONTAINER CONSTRUCTION a <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f l GAUGE ( ) INCHES t ) CM ( ) UNKNOWN <br /> B. ( l 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( l 02 NON-VAULTED t ) 03 UNKNOWN <br /> C. f ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED t } 03 LINED <br /> 0., 01 Ol CARBON STEEL ( 102 STAINLESS STEEL ( l 03 FIBERGLASS t ) 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( } 09 COMPOSITE ( l 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER. <br /> HSC04-070185 (10/18/85) PAGE I <br /> is 0 <br />