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/ j ���jj,, STATE ID NUMBER 00000052297001 <br /> APPLICATION FOR PERMIT TO dPERATE UNDERGROUND STORAGE TANK <br /> ( ) <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT 07 ( ) 09 DELETE FROM FILE (NO FEEL <br /> ( ) 02 CONDITIONAL PERMIT f ) 06 AMENDED PERMIT 8 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIOUAL OR PUBLIC AGENCY) PUBLICAGENCY ONLY <br /> S. T. SERVICES f 1 O1 FED ( 1 02 STATE 1 7 03 LOCAL <br /> STREET ADDRESS CITY STATE ZZP <br /> 2941 NAVY DR. STOCKTON CA 45206 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> WILLIAMS TANK LINES MIKE WILLIAMS <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 2941 NAVY DR WASHINGTON ST. <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95206 <br /> MLIL:NG ADDRESS CITY STATE ZIP <br /> 2941 NAVY OR STOCKTON CA 95206 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-944-5613 ( ) 01 GASOLINE STATION (X) 02 OTHER TRANSPORT <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 1 <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/ARCA CODE <br /> WILLIAMS. MIKE 209-944-5613 SAME - - <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 /> B. MANUFACTURER (IF APPROPRIATE)' YEAR MFG: C. YEAR INSTALLED 1978 ( ) UNKNOWN <br /> 0. CONTAINER CAPACITY' 1000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: (X) Ol WASTE ( ) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( 1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( l 04 DIESEL (X) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT' [ ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL l 7 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> f ) 06 ALUMINUM ( ) 07 STEEL CLAD l ] 08 BRONZE ( ) 09 COMPOSITE ( 1 10 NON-METALLIC <br /> f ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />