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• 4 .e (4,4r- • STATE ID NUMBER 00000014642002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> f 101 NEW PERMIT ( ) 05 RENEWED PERMIT � GT ANK CLQSED f ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT f ) 06 AMENDED PERMIT f ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPOBATION.INDIVIDUAL OR PUBLIC AGENCY) ' PUBLIC AGENCY ONLY <br /> FARM AND INDUSTRIAL SUPPLY COM - ( ) 01 FED f ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 1648 SHAW ROAD STOCKTON CA 95205 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> FISCO WAREHOUSE CY HENNINGER, WHSE HER. <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1648 SHAW ROAD FREMONT <br /> CITY COUNTY ZIP <br /> STOCKTO14 SAN JOAQUIN 95205 <br /> R <br /> NG ADDRESS CITYBOX 2168 STATE ZIP <br /> STOCKTON CA 95201 <br /> W/AREA CODE TYPE OF BUSINESS <br /> 66-3444 ( ) O1 GASOLINE STATION (X) 02.OTHER STORE <br /> R OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> 2' <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA COOK <br /> PARROTT, LARRY 209-466-3444 PARROTT, LARRY 209-478-4335 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 2 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 550 GALLONS ( ) 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 SOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL ( ) 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM (XI UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. f ) 01 DOUBLE WALLED ( l 02 SINGLE WALLED ( 1 03 LINED <br /> D. ( 101 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD f 7 08 BRONZE f ) 09 COMPOSITE f 1 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( 1 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />