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0 0 STATE IO NUMBER 00000014642001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) <br /> 01 NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 09 DELETE FROM FILE (NO FEE) <br /> f 102 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT GE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COP.PORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> FARM AND INDUSTRIAL SUPPLY COM ( 1 01 FED ( 1 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY <br /> $ <br /> TATE IIP <br /> 1648 SHAW ROAD STOCKTON CA 95205 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> FISCO WAREHOUSE CY HENNINGER, WHSE MGR. <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1648 SHAW ROAD FREMONT <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 1 95205 <br /> MAILING ADDRESS CITY STATE ZIP <br /> P.O. BOX 2168 STOCKTON CA 95201 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-466-3444 ( ) 01 GASOLINE STATION (X) 02 OTHER STORE <br /> NUMBER 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/ARBA CODE <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 1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 550 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: f ) 01 WASTE (X1 02 PRODUCT <br /> F. HOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> f ) 01 UNLEADED f 1 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL f 7 05 WASTE OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE f ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED l ) 03 LINED <br /> D. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL f ) 03 FIBERGLASS f l 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE f ) 09 COMPOSITE f ) 10 NON-METALLIC <br /> (XI 12 UNKNOWN ( 1 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />