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APPLICATION FOR PERMIT TO OPERATE UNDERGROUNDSTORAGE ATE ID NUMBER <br /> 00000033564001 <br /> 01 NEW PERMIT <br /> ( ! TANK <br /> 02 CONDITICNAL 05 RENEWED PERMIT ( 1 07 TANK CLOSED <br /> ( l PERMIT ( J 06 AMENDED PERMIT <br /> ( l 08 MINOR CHANGE (NO SURCHARGE)) 04 DELETE FROM FILE (NO FEE) <br /> I OWNER <br /> NAME(C^-RPflRATICN,_NDIVIDUAL ORrPU511C AGENCY) <br /> DEPARTMENT OF THE YOUTH AUTHOR;T <br /> PUBLIC AGENCY ONLY <br /> STREET ADDRESS ( ) 01 FED { ) 02 STATE ( ) 03 LOCAL <br /> 4241 WILLIAMSBOURGH DRIVE CITY —- _ <br /> SACRAMENTO STATE ZIP <br /> II FACILITY CA 95823 <br /> FACILITY NAME <br /> NORTHERN CALIFORNIA YOUTH CENTt'A <br /> t,,)­rt% DEALEP/FOREMANlSL)PERVISOP <br /> STPE17 ADDRESS fit./ 4!�✓,G� �� g� <br /> 7650 SO. NEWCASTLE ROAD NEAPEST CROSS STPEET <br /> CITY <br /> FRWY 99 & ARCH ROAD <br /> STOCKTON COUNTY <br /> S+.';-' <br /> MAILING ADDRESS SAN JOAQUIN ZIP <br /> P.O. BOXjAso— + U CITY _ <br /> STOCKTON STATE zIP <br /> PHO).E W/APEA CODE CA <br /> 209-*wpgw p j � TYPE OF BUSINESS <br /> 7 <br /> NUMBER OF CONTAINERSC ) 01 GASOLINE STATION (X) 02 OTHER YOUTH CENTER <br /> RURAL AREAS ONLY : TOWNSHIP <br /> RANGE SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: N.AME(LAST NAME FIRST) AND PHONE W/APEA CODE <br /> 4ihili~i ED 209-944-6351 NIGHTS: NAME(LAST NAME FIRST) AND PHONE E <br /> W/AP.-4 CODE <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACCONTAINER <br /> IV DESCRIPTION <br />[A.:[X�) 01 TANK i ) 04 OTHER: <br /> CONTAINER NUMBER 001 <br /> B. :tlA— <br /> NUFACTUPER (IF APPROPRIATE): <br /> EYEARMFG: C. YEAR INSTALLED 1966 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 2000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: C ) O1 WASTE (X) 02 PRODUCT <br /> F. (_ S THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( <br /> 01 UNLEADED X) 01 YES i l 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 03 PREMIUM [ ) 04 DIESEL ( 1 05 WASTE OIL { ) 06 <br /> OTHER <br /> CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( f GAUGE ( ] INCHES C ) CM (X) UNKNOWN <br /> 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT! (X) 02 NON-VAULTED ( ! 03 UNKNOWN <br /> 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> i. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS { ) 04 POLYVINYL CHLORIDE ( ) 05 CONCPETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( l ( ) I0 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER= 09 COMPOSITE <br /> C04-070185 (10/18/85) <br /> PAGE I <br /> nt . <br /> n. <br /> NPEA <br /> FOR LOCAL AGENCY USE ONLY <br /> ADMINISTRATING AGENCY ID <br /> J4 �' V CITY CODE COUNTY CODE <br /> CONTACT PEPSCN <br /> PHpN -&7 CODE Y 31� <br /> DATE OF LAST INSPECTION IN COMPLIANCE REKNIT APPROVAL DATE TRANSACTION DATE <br /> t 1 01 YES t ) 02 NO LOCAL PERMIT IO # <br /> ISC04-070185 {10/18/651 <br /> PAGE 2 <br /> 0 <br />