Laserfiche WebLink
STATE ID NUMBER 00000011177001 <br /> APPLICATION FOR PERMIT TO OPE ATE UNDERGROUND STORAGE TANK <br /> �1 NEW PERMIT ( ) 05 RENEWED PERMIT A 6 7.ZK - ( ) 09 DELETE FROM FILE (NO FEE) <br /> D2 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPCRATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> ANGELICA HEALTHCARE SERVICES G ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET .ADDPESS CITY STATE ZIP <br /> 600 NORTH EUCLID - 3RD FLOOR ANAHEIM CA 92801 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOPEMAN/SUPERVISOR <br /> 'XCLUSIVE LINEN SUPPLY FRANK WALLACE <br /> STPE°T AOD;w SS NEAREST CROSS STREET <br /> 1145 SOUTH SIERRA NEVADA JACKSON <br /> CITY COUNTY zip <br /> STOCKTON SAN JOAQUIN 95205 <br /> MAIL=N3 ADDRESS CITY STATE ZIP <br /> 1145 SOUTH SIERRA NEVADA STOCKTON CA 95205 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-941-4327 i ) 01 GASOLINE STATION (X) 02 OTHER LINEN SUPPLY <br /> NUMBER OF CONTAINERS PUPAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAM= FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> WALLACEr ImAWMI166 209 ' WALLACE209-478-4658 <br /> Y c i) Z4 7 YI , 7 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( 1 04 OTHER: CONTAINER NUMBER G-17-1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1972 1 l UNKNOWN <br /> �o <br /> D. CONTAINER CAPACITY: -"fl�ONS [ ) UNKNOWN E. DOES THE CONTAINER STORE: E ) 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 (X) 02 REGULAR ( ) 03 PREMIUM E ) 04 DIESEL i ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( I INCHES ( ) CM (X) UNKNOWN <br /> B. i I Cl VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( l 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( 1 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN i ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />