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w <br /> • STATE ID NUMBER 00000011281001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> [�01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 02 CONDITIONAL PERMIT f ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPOP.ATION,INDIVZOUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CITY OF STOCKTON ( ) 01 FED ( ) 02 STATE j.V 03 LOCAL <br /> STREET EL DORS OITY STATE ZIP <br /> 425 N. EL DORADO BTOCKTON CA 95202 <br /> II FACILITY <br /> FACILITY <br /> ! S�tl � n,� DEALER/FOREMAN/SUPERVISOR <br /> (( T�+`�1'- COMPANY OFFICERS <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1501 PICARDY DR. PERSHING <br /> CITY COUNTY ZIP <br /> STOCKtON SAN JOAQUIN 95203 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 1501 PICARDY DR. STOCKTON CA 95203 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-462-3235 ( ) 01 GASOLINE STATION (X) 02 OTHER FIRE STATION <br /> NUMBER OF C04TAI NERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> 1 N/A N/A N/A <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NZ GHTS•�,�+AME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> a^ 209 � 'f(oy� a" .✓is che! �o -yG`f 5`(oW <br /> --V - <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: C. YEAR INSTALLED 1942 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 500 GALLONS ( l UNKNOWN E. DOES THE CONTAINER STORE: ( 1 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL ( l 05 WASTE OIL [ ] 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( 1 GAUGE ( ) INCHES ( 1 CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) f ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. f 7 01 DOUBLE WALLED f. Y 02 SINGLE WALLED ( ] 03 LINED <br /> D., ( 1 01 CARBON STEEL f ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( 7 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 7 07 STEEL CLAD f 1 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> i <br /> i <br />