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0 0 <br /> STATE ID NUMBER 00000018680003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 1 NEW PERMIT f ) 05 RENEWED PERMIT f 1 07 TANK CLOSED f 1 09 DELETE FROM FILE (NO FEE) <br /> /C ) 02 CONDITIONAL PERMIT f 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPOP.ATION.INOIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> PARKER HOLT ( ) 01 FED ( ) 02 STATE ( ] 03 LOCAL <br /> STREET ADDRESS CITYSTATE ZIP <br /> 4000 WAGNER HTS RD STOCKTON CA 95209 <br /> II FACILITY <br /> FACILITY NAME REALE /FOREMAN/SUPERV ISOR <br /> PARKER HOLT <br /> STREET ADDRESS NEAP. 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 (X) 02 OTHER RESIDENCE <br /> NUMBER OF CONTAINERS RURAL AREAS ONLYTOWNSHIP 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/APEA 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 ( ) 04 OTHER: CONTAINER NUMBER 3 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1974 C. YEAR INSTALLED 1974 f ) UNKNOWN <br /> D. CONTAINER CAPACITY: 550 GALLONS ( 1 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 /> (X) 01 UNLEADED f 1 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL f ) 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE f ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( 1 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( 1 03 LINED <br /> D. ( ) 01 CARBON STEEL ( 1 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( l 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( 3 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />