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3 STATE ID NUMBER 00000016663010 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) 01 NEW PERMIT ( ) 05 RENEWED PERMIT (,V 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( 1 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPOPATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> MCCORMICK AND BAXTER CREOSOISN6- ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STP'EET ADDRESS CITY STATE ZIP <br /> 6900 N EDGEWATER PORTLAND OR 97203 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/ <br /> MCCORMICK AND BAXTER CREOSOTIN&- BILL FEGLEY( ( lal'1.'�" r <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 /> PHONE W/AREA CDOE TYPEOF 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. (>O 01 TANK w<04 OTHER: CONTAINER NUMBER 010 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> Id oa <br /> D. CONTAINER CAPACITY: GALLONS IX1 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 (X1 02 NO IF YES CHECK APPROPRIATE 0 (ES):! <br /> ( 1 <br /> 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ) 06 OTHERS-�"- <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE f ) INCHES f ) 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 l 03 LINED <br /> 0. (X) 01 CARBON STEEL ( 1 02 STAINLESS STEEL f 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> f ) 06 ALUMINUM ( ) 07 STEEL CLAD ( l 08 BRONZE ( l 09 COMPOSITE f ) 10 NON-METALLIC <br /> ( l 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />