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r , •� STATE IO NUMBER 0000004 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 1 1 01 NEW PERMIT 1 ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( 1 09 DELETE FROM FILE (NO <br /> ( ) 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPOPATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> ESTATE OF DECKER MCCALLISTER ( ) 01 FED ( l 02 STATE ( ) 03 LOCAL <br /> STP''-ET ADDRESS CITY STATE ZIP <br /> 1633 OLD BAYSHORE HIGHWAY BURLINGAME CA 94010 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> SYSTEM 99 BILL BUTLER <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 601 S. VENTURA AVENUE HAZELTON <br /> CITY COUNTY <br /> ZIP <br /> STOCKTON SAN JOAQUIN 96203 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 601 S. VENTURA AVENUE STOCKTON CA %203 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-465-3416 ( ) 01 GASOLINE STATION (X) 02 OTHER COMMON CARRIER <br /> NUMBE P, OF CONTAI NEP.S PUPAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 2 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAM--c(LAST NAME FIRST) AND PHONE W/APEA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/APEA CODE <br /> BUTLER( BILL 209-465-3416 BUTLER, BILL 209-957-2057 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 526 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1966 C. YEAR INSTALLED 1966 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS ( I 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 ( ) 02 REGULAR ( 1 03 PREMIUM (X) 04 DIESEL ( 1 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE f 1 INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( 1 03 LINED <br /> D. (X) 01 CARBON STEEL ( 1 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 1 07 STEEL CLAD f 1 08 BRONZE f 1 09 COMPOSITE ( l 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> 1 <br />