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�/ <br /> STATE ID NUMBER 00000019327001 <br /> APPLICATION FOR PERMIT TO OP- �G OUND STORAGE TANK <br /> f ) <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT �('7 TANK CLOSED ' ( l 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ) 08 MTRUR__CR, l G=(NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPCRATION,INDIVIDUAL OR PUBLIC AGENCY) FUB) <br /> IC AGENCY ONLY <br /> ALMA LAECHLER 01 FED ( ) 02 STATE ( l 03 LOCAL <br /> --] <br /> STREET .ACOPESS CITY STATE ZIP <br /> 4356 RIVIERA DR STOCKTON CA 95204 <br /> II FACILITY <br /> FACILITY NAPE DEALER/FOREMAN/SUPERVISOR <br /> ALMA LAECHLER <br /> STREET 4DORESS NEAREST CROSS STREET <br /> 4356 RIVIERA DR <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95204 <br /> MAILING .ADDRESS CITY STATE ZIP <br /> 4356 RIVIERA DR SAME CA 95204 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-948-4280 ( ) 01 GASOLINE STATION (X) 02 OTHER HOME <br /> NUMBER, OF CONTAINERS RURAL AREAS ONLY . TOWNSHIP PANGS SECTION <br /> 1 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME( L.4ST NAME FIRST) .AND PHONE W/AREA CODE NIGHTS: N.4ME(L.4ST NAME FIRST) AND PHONE W./AREA CODE <br /> PHILIP LAECHLER JR. 209-931-4248 SAME - <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( l 04 OTHER: CONTAINER NUMBER 0000000001 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG TC. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 500 GALLONS f ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 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 (X) 03 PREMIUM ( ) 04 DIESEL ( l 05 WASTE OIL ( l 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) ( ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( 1 02 SINGLE WALLED ( ) 03 LINED <br /> D. ( l 01 CARBON STEEL ( l 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( l 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> t <br />