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4=94> <br /> STATE ID NUMBER 00000016663012 <br /> APPLICATION FOR PERMIT TO OPERATE UN ERGROUND STORAGE TANK <br /> ( ) <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED 016, 09 DELETE FROM FILE (NO FEE) <br /> ( 7 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPCBATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> MCCORMICK AND BAXTER CREOSOTING ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 6900 N EDGEWATER PORTLAND OR 97203 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> MCCORMICK AND BAXTER CREOSOTING- BILL FEGLEY7 pl;xW M c <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1214 W. WASHINGTON STREET PERSHING <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95203 <br /> MAILING ADDRESS CITY STATE ZIP <br /> P.O. BOX 1728 STOCKTON CA 95201 <br /> PPC6E W/APEA CODE TYPE OF BUSINESS <br /> 209-465-5767 ( ) 01 GASOLINE STATION (X) 02 OTHER WOOD PRESERVATION <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 19 <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/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. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 012 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1965 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: GALLONS (X) UNKNOWN E. DOES THE CONTAINER STORE: (X) 01 WASTE ( ) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED J.)W 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL f ) 05 WASTE OIL f 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. (X) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) f ) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ] 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( ) 03 LINED <br /> D. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS l ) 04 POLYVINYL CHLORIDE (X) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ] 08 BRONZE f 1 09 COMPOSITE ( 1 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> • r <br />