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0 <br /> STATE ID NUMBER 00000059193003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( 1 01 NEW PERMIT ( } 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( 1 09 DELETE FROM FILE (NO FEE) <br /> 2 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPORATION,INDIVIDUAL OR P ELIC AGENCY) PUBLIC AGENCY ONLY <br /> 1 -T IC' ( ) 01 FED { } 02 STATE ( } 03 LOCAL <br /> STREET ADDRESS CITY STATE F_l� <br /> zRl 5j` STOCKTON CA <br /> II FACILITY <br /> FACILITY NAME DEALER/FCREMAN/S PE VISOR <br /> WATER FRONT YACHT HARBOR ROY A. GRUWELL <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 333 TULEBERG LEVEE CENTER <br /> CITY COUNTY <br /> Z <br /> IP <br /> STOCKTON SAN JOAQUIN <br /> MAILING ADDRESS CITY STATE ZIP <br /> 333 TULEBERG LEVEE STOCKTON CA 95203 <br /> PHONE W/AP.EA CODE FTYPEOF BUSINESS <br /> 209-943-1848 01 GASOLINE STATION (X) 02 OTHER MARINA <br /> NUMDEa OF CONTAINER$ RURAL AREAS ONLY TOWNSHIP RANGE SECTIbN <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> F <br /> YS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> UWELL, ROY 209-943-1848 GRUWELL, ROY 209-369-5753 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 3 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1981 ( 1 UNKNOWN <br /> 0. CONTAINER CAPACITY: 5000 GALLONS ( ) UNKNOWN 1E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER ORE MOTOR VEHICL€ FUEL OR W5TE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) <br /> 01 UNLEADED 02 REGULAR ( ) 03 PREMIUM ) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1/4 ( 1 GAUGE (X) INCHES { 1 CM ( 7 UNKNOWN <br /> B. ( l 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) C>O 02 NON-VAULTED W4-03 UNKNOWN <br /> C. ( l 01 DOUBLE WALLED NI-02 SINGLE WALLED ( 1 03 LINED J`f' <br /> D, H(} 01 CARBON STEEL ( 1 02 STAINLESS STEEL (l[) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 1 07 STEEL CLAD ( 1 08-nONZE ( } 09 COMPOSITE [ 1 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> kL 1 0 0 <br />