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• • STATE ID NUMBER 00000049766003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) 01 NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( 7 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT OB MING CHA (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATICN.-NDIVICUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> FRANCES F. OKAMOTO ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 431 WEST JEFFERSON STOCKTON CA 95206 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> OKAMOTO SERVICE KATSUMI UYEDA <br /> STPEET ADDRESS NEAREST CROSS STREET <br /> 145 SOUTH SUTTER WASHINGTON ST. <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAgUIN95202 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 145 SOUTH SUTTER STOCKTON CA 95202 <br /> E <br /> W/AREA CODE TYPE OF BUSINESS43-1158 (X) O1 GASOLINE STATION ( 1 02 OTHERR. OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> 4 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAIS: NACE(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 /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER III <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1968 ( ) UNKNOWN <br /> 0. CONTAINER CAPACITY: 10000 GALLONS ( 1 UNKNOWN E. DOES THE CONTAINER STORE: l 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 BOX(ES): <br /> ( ) 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( 1 04 DIESEL ( 7 05 WASTE OIL [ 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f 1 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 ( ) 02 SINGLE WALLED ( ) 03 LINED <br /> 0. (X) 01 CARBON STEEL ( 1 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( 1 06 ALUMINUM f 1 07 STEEL CLAD f 1 08 BRONZE ( 1 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />