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STATE ID NUMBER 00000038750002 <br /> APPLICATION FOR PERMIT TO dWE UNDERGROUND STORAGE TANK <br /> ( ) O1 EW PERMIT ( ) 05 RENEWED P€RMITTANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 2 CONDITIONAL PERMYT f ) 06 AMENDED PERMIT ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPOP.ATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> PORT OF STOCKTON I( ) 01 FED ( ) 02 STATE t ) 03 LOCAL <br /> STFEET ADDPESS CITY STATE ZIP <br /> 2201 W. WASHINGTON ST. STOCKTON CA 95203 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> PORT OF STOCKTON <br /> STREET ADDPESS NEAPEST CROSS STREET <br /> 2201 W. WASHINGTON ST. RD. 14 & RD. G <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95203 <br /> MAILING ADDRESS CITY STATE ZIP <br /> P.0 BOX 2089 �STKN. CA 95201 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 946-024-6 t 1 01 GASOLINE STATION (X) 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP PAN'S= SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> OAYS: NAME(L.AST NAME FT—PST) AND PHONE W/AREA CODE NIGHTS: NAMgE(LAST NAME FIRST) AND PHONE\W/ARE'A!/CODE <br /> B ; o = 209-946-0246 SAME 1 Yl I l� ✓ Y (P <br /> �OMPLETIE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER #2 <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG= C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY 1000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (XI 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 /> 'I) 01 UNLEADED { ) 02 ULAR ( ) 03 PREMIUM t ) 04 DIESEL ( l 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> a <br /> A. THICKNESS OF PRIMARY CONTAINMENT: t ) GAUGE ( ) INCHES ( 1 CM (X) UNKNOWN <br /> B. ( l 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( N—VAULTED (X) 03 UNKNOWN <br /> C. { 1 01 DOUBLE WALLED (X,0E WALLED ( 1 03 LINED <br /> 0. ( l 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( l 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> C ) 06 ALUMINUM (X) 07 STEEL CLAD f 1 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON—METALLIC <br /> ( l 12 UNKNOWN ( ) 13 OTHER: <br /> KSC04-070185 (10/18/85) PAGE 1 <br />