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I <br /> STATE ID NUMBER 00000011286001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ?1'01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED t ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAM9(COPP0RATION.INDIV:DUAL OR P191I1 AGENCY) PUBLIC AGENCY ONLY <br /> CITY OF STOCKTON ( ) 01 FED ( ) 02 STATE L-lL"3 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 425 N. EL DORADO STOCKTON CA 95202 <br /> II FACILITY <br /> PACSLSTY NAME LDEALER/FOREMAN/SUPERVISOR <br /> s4oC(� -&-^ COMPANY OFFICERS <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1701 W. WASHINGTON FRESNO <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95203 <br /> MAILING ADDRESS CITY STATE ZIP <br /> BAMS-ES7tBBVE 0. STOCKTON CA 95203 <br /> RHONE W/AREA COLE TYPEOF BUSINESS <br /> 209-462-1094 ( ) 01 GASOLINE STATION (X) 02 OTHER FIRE STATION <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 1 N/A N/A N/A <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> O A'iS:yyN��A�C�E(LAPT�(NAME FIRST) AND,/,P'�}ONE W//AREA CODE NIGHTS: NAMECLAST NAME FIRST) AND PHONE W/ARCA CODE <br /> Vb7 4,�er ao9-7f7 11kl .v I SAME -209 -VV S/G c/Fj <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: C. YEAR INSTALLED 1954 t ) UNKNOWN <br /> D. CONTAINER CAPACITY: 550 GALLONS ( ) UNKNOWN E. DOE TME CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASOIL ? ( 1 O1 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ESI: <br /> ( 1 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( 04 DIES L l 1 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> 0 <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (1X 02 SINGLE WALLED ( ) 03 LINED <br /> 0. ( ) 01 CARBON STEEL [ ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( 105 CONCRETE <br /> ( ) 06 ALUMINUM ( l 07 STEEL CLAD ( 1 08 BRONZE ( ) 09 COMPOSITE f 1 10 NON-METALLIC <br /> ' (X) 12 UNKNOWN f ) 13 OTHER: <br /> HSC04-070185 (10/18/851 PAGE 1 <br />