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4��STATE ID NUMBER 00000016663018 <br /> APPLICATION FOR PERMIT TO 0 RATE UNDERGROUND STORAGE TANK <br /> ( 1 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED L.Y09 DELETE FROM FILE (NO FEE) <br /> ( 102 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION.-NO:VIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> MCCORMICK AND BAXTER CREOSOT'"&- ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STFEET ADDRESS CITY STATE ZIP <br /> 6900 N EDGEWATER PORTLAND OR 97203 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN SUPERVISOR <br /> MCCORMICK AND BAXTER CREOSOTIN& BILL FEGLEY7 11a;,Cf <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1214 W. WASHINGTON STREET PERSHING <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN i 95203 <br /> MAILING ADDRESS CITY STATE ZIP <br /> P.O. BOX 1728 STOCKTON CA 95201 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-465-5767 ( 1 01 GASOLINE STATION (X) 02 OTHER WOOD PRESERVATION <br /> NUMBER OF CONTAINERS RURAL APEAS ONLY TOWNSHIP RANGE SECTION <br /> 19 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAM° FIPST) AND PHONE W/AREA CODE NIGHTS: NAMECLAST NAME FIRST) AND PHONE W/AREA CODE <br /> SHIBA, LARRY 209-465-5767 SHIBA, LARRY 209-465-5767 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. f 1 01 TANK (X) 04 OTHER: SUMP CONTAINER NUMBER 018 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: GALLONS (X1 UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( 1 01 YES (X) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED f ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( 1 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> a <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( 1 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 f 1 03 LINED <br /> D. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE (X) 05 CONCRETE <br /> ( ) 06 ALUMINUM f ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> � ( ) 12 UNKNOWN [ ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> i • <br />