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MSTATE IO NUMBER 00000018680002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) 01 NEW PERMIT ( ) 05 .RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> f 1 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COP.PORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> PARKER HOLT ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS <br /> 4000 WAGNER HTS RD CITY STATE ZIP <br /> STOCKTON CA 95209 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> PARKER HOLT <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 4000 WAGNER HTS RD <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95209 <br /> MAILING ADDRESS CITY STATE ZIP <br /> BOX 8130 STOCKTON CA 95208 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-466-6000 ( ) 01 GASOLINE STATION (X1 02 OTHER RESIDENCE <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SE CIO <br /> 3 N <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAMECLAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> HOLT, PARKER 209-466-6000 HOLT PARKER 209-477-0543 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( 1 04 OTHER: CONTAINER NUMBER 2 <br /> B. MANUFACTURER (IF APPROPRIATEI: YEAR MFG: 1953 C. YEAR INSTALLED 1953 f ) UNKNOWN <br /> D. CONTAINER CAPACITY: 550 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( 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 ( ) 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL I ) 05 WASTE OIL ( 106 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( 1 INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 0.2 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( 1 03 LINED <br /> D. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS I ) 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> ( ) 06 ALUMINUM C ) 07 STEEL CLAD ( 1 08 BRONZE ( ) 09 COMPOSITE f 1 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( 1 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> /�/,� a) 0 W <br />