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STATE ID NUMBER 00000019687001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> X( _01 NEW PERMIT ( ) 05 RENEWED PERMIT ( 1 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> I ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NA`9E(CORPORATION.INDIVIDUAL CP PUBLIC AGENCY) PUBLIC}-s�f PUBLIC AGENCY ONLY <br /> ,F (� Q ( ) 01 FED ( ) 02 STATE i 1 03 LOCAL <br /> STREET ADDRESSCIT1' STATE ZIP <br /> T ff �r !.t i SACRAMENTO CA 95814 <br /> II FACILITY <br /> FACILITY NAM= -ff DEALER/FOREMAN/SUPEPVISCR <br /> STREET -:ODPESS 7 7 v NEAREST CROSS STREET <br /> 7650 NEWCASTLE ROAD ARCH <br /> S". Y COUNTY ZIP <br /> TOCKTON SAN JOAQUIN G7� <br /> MAILING ADDRESS <br /> ICS <br /> TY STATEP.O. Box <br /> J4 <br /> P.O. CA <br /> PHONE W/APEA CODE TYPE OF BUSINESS <br /> 209 T Q 01 GASOLINE STATION (X) 02 OTHER .STzAZ¢--C T <br /> NUMBER OP ONfiAINE?S RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> LAYS: N.AME(LAST NAME FIPST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> d <br /> CO PLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( 1 04 OTHER. CONTAINER NUMBER I <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: /( CJ GALLONS (X) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE ( 1 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WA�T1STEOIL ? ( ) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> I ) 01 UNLEADED [ ) 02 REGULAR [ 1 03 PREMIUM ' 04 DIESEL ( 1 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( 1 GAUGE ( l INCHES ( ) CP1 (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) I ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( J 01 DOUBLE WALLED (?(1 02 SINGLE WALLED ( l 03 LINED <br /> D. t 001 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE f ) 09 COMPOSITE ( 1 10 NON-METALLIC <br /> ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE I <br />