Laserfiche WebLink
• • STATE ID NUMBER 00000049766001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT <br /> ( 7 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORFCPATIO N,I�\D:V:CVAL OR PUBLIC AGENCY) <br /> FRANCES F. OKAMOTO PUBLIC AGENCY ONLY <br /> [ ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS <br /> 431 WEST JEFFERSON carr STATE ZIP <br /> STOCKTOH CA 95206 <br /> II FACILITY <br /> FACILITY NAME <br /> OKAMOTO SERVICE DEALER/FOREMAN/SUPERVISOR <br /> KATSUMI UYEDA <br /> STREET ADDRESS <br /> 145 SOUTH SUTTER NEAREST CROSS STREET <br /> WASHINGTON ST. <br /> CITY <br /> STOCKTON COUNTY ZIP <br /> SAN JOAQUIN 95202 <br /> MAILING ADDRESS <br /> 145 SOUTH SUTTER CITY STATE zIP <br /> STOCKTON CA 95202 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-943-1158 (X) 01 GASOLINE STATION ( ) 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLV TOWNSHIP <br /> 4 RANGE SECTION <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 CODE <br /> OKAMOTO, FRANCES 209-464-8287 SAME <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> F(X) 1 TANKE(IF <br /> EAPPROPRIATEE): <br /> ER: CONTAINER NUMBER I <br /> ACTUR E <br /> YEAR MFG: C. YEAR INSTALLED 1968 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 5000 GALLONS ( 7 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 ( 1 02 REGULAR (X) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( ) 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. (X) 01 CARBON STEEL ( 1 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( 1 08 BRONZE ( ) 09 COMPOSITE ( 110 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> ISC04-070185 (10/18/85) <br /> PAGE 1 <br />