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cg4 <br /> 1, <br /> STATEIDNUMBER 00000038750004 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STOR GE TANK <br /> 01 W PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED [ Q4 DELETE FROM FILE (NO FEE) <br /> 4 2 CONDITIONAL PERMIT [ 1 06 AMENDED PERMIT [ i 08 MINOR CHANGE (NO SURCHARGE <br /> z OWNER <br /> NAiE(COPPORATION,INOIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> PORT OF STOCKTON f 1 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADCFESS CITY STATE ZIP <br /> 2201 W. WASHINGTON ST. STOCKTON CA 95203 <br /> II FACILITY <br /> FA-IL'TY NA:IE DEALER/FOREMAN/SUPERVISOR <br /> PORT OF STOCKTON <br /> STREET AODPESS NEAREST CROSS STREET <br /> 2201 W. WASHINGTON ST. RD. 14 A RD. G <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95203 <br /> ,'.AILSNG A;)DRESSCITY STATE ZIP <br /> P.0 BOX 2089 STKN. CA 95201 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 946-024-6 ( ) 01 GASOLINE STATION (X) 02 OTHER <br /> NUMBER dFCNTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME( LAST NAME FIRST) AND PHONE W/APEA CODE NIGHTS: NAME(LAST NAME IRST) AND PHONE /ARE <br /> A <br /> CODE / <br /> 209-946-0246 SAME ( YL 1 - I t - 61 <br /> I v1,yf-v9k4L_c r_ <br /> �-- <br /> - OLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK € ) 04 OTHER: CONTAINER NUMBER 44 <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY' � � GALLONS € ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? IX) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> 01 UNLEADED (OdM 02 REGULAR ( ) 03 PREMIUM ( 1 04 DIESEL ( ) 05 WASTE OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( 1 GAUGE ( 1 INCHES ( 1 CM (X) UNKNOWN <br /> B. ( 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) [ ) 02 -VAULTED (X1 03 UNKNOWN <br /> C. ( } 01 DOUBLE WALLED ( 02 WALLED ( ) 03 LINED <br /> D. ( i 01 CARBON STEEL ( ) 02 STAINLESS STEEL. ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( i 06 ALUMINUM (X) 07 STEEL CLAD ( 1 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> t 1 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />