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i ! <br /> STATE ID NUMBER 00000033564002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 01 NEW PERMIT ( i 05 RENEWED PERMIT t 1 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 02 CONDITICNAL PERMIT f ) 06 AMENDED PERMIT f } 08 MINOR CHANGE (NO SURCHARGE) <br /> z OWNER <br /> NAME(CORFORATlON,INOIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> DEPARTMENT OF THE YOUTH AUTHOR01 FED f ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 4241 WILLIAMSBOURGH DRIVE SACRAMENTO CA 95823 <br /> II FACILITY <br /> FACILITY NAME / DEALER/FOREMAN/SUPERVISOR <br /> NORTHERN CALIFORNIA YOUTH CENTr,C- �(Al%�'C (y[!A4�7Le�1 <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 7650 SO. NEWCASTLE ROAD FRWY 99 & ARCH ROAD <br /> CITY COUNTY ZIP 9S� <br /> STOCKTON SAN JOAQUINqdakf <br /> nILTNG ADDRESS CITY STATE ZIR ` J <br /> P.0. BOXNisi? + ST(T)1( CA S yr�lQ <br /> PHONE. W/APER CCDM TYPE OF BUSINESS <br /> 209- crC �� f ) 01 GASOLINE STATION (X) 02 OTHER YOUTH CENTER <br /> NUMBER OF ONTAINEPS RURAL AREAS ONLI' TOWNSHIP RANGE SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS; NAME(LASTNAME FIRST) AND PHCNE W/AREA CODE NIGHTS. NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> LINDEMYER, ED 209-944-6351 lu==2:ry r <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK f ) 04 OTHER: CONTAINER NUMBER 002 <br /> S. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1976 t ) UNKNOWN <br /> D. CONTAINER CAPACITY: 2000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WA TE OIL ? (X) 01 YES ( 1 02 NO IF YES CHECK APPROPRIATE BOX(ES)- <br /> WPO~Eii 1( <br /> ) 02 REGULAR t } 03 PREMIUM 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> S. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( 1 03 LINED <br /> 0. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />