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STATE ID <br /> NUMBER 00000006823002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> Lr [ ) 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( 1 07 TANK CLOSED t ) 09 DELETE FROM FILE (NO FEE) <br /> i ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( l 08 MINOR CHANGE (NO SURCHARGE) <br /> I ONNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> DOUGLAS J. TROTTER ( 1 01 FED t ) 02 STATE ( ) 03 LOCAL <br /> STPEET ADDRESS CITY STATE=Zl;l125 SO. SUTTER STREET STOCKTONCA2 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> CLARK GARAGE DOUGLAS J. TROTTER <br /> STP.EET ADDPESS NEAREST CROSS STREET <br /> 125 SO. SUTTER STREET WASHINGTON ST. <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95202 <br /> MAILING ADDRESS =CSITTOICKTON <br /> Y STATE ZIP <br /> 125 SO. SUTTER STREET GA 95202 <br /> PHONE W/AREA CODE FTYOE OF BUSINESS <br /> 209-946-9183 01 GASOLINE STATION (X) 02 OTHER GARAGE <br /> NUMBER CF CONTA.NERS _ PUPAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 2 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DA'TS: INA', (LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(L.AST NAME FIRST) AND PHONE W/.AREA CODE <br /> TROTTER, DOUGLAS 209-946-9183 TROTTER, DOUGLAS 209-477-7855 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORA FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER =CONTAINER NUMBER TWO <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1947 C. YEAR INSTALLED 1947 f ) UNKNOWN <br /> D. CONTAINER CAPACITY: 500 GALLONS ( 1 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 /> (X) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM 6 1 04 DIESEL ( ) 05 WASTE OIL ( l 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1/2 ( ) GAUGE (X) INCHES ( 1 CM ( 1 UNKNOWN <br /> B. (X) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (XI 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS [ ] 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( l 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> [ ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />