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APPLICATION FOR PERMITd ) d )) <br /> TO OPERATE) STATE <br /> TATE ID <br /> NUMBER 01MEW PERMIT 000000 38917002 CONDITIONAL PERMIT 05 RENEWED PERMIT ( UNDERGROUNLSTORAGE TANK AMENDED PERMIT 07 TANK COSED <br /> I <br /> OWNER f J 08 MINOR CHANGE (NO SURCHARGE()( ) 09 DELETE FROM FILE (NO FEE) <br /> NAME(CDRPOp <br /> ALBERT ATION,INDiVIDVAt OR p <br /> ELEANOR W. DAVIDSON ustiC AGENCY) <br /> STREET ADDRESS <br /> 1212 BROADWAY PUBLIC AGENCY ONLY <br /> ( ) 01 FED ( ) D2 STATE <br /> I I CITY ( ) 03 LOCAL <br /> FAC I L I TY OAKLAND STATE <br /> CA zip <br /> FACILITY ;y,;,ME 94612 <br /> BEACON STATION 4419 <br /> STREET AD DEALER/FOREMAN/SUP€RVISOR <br /> 2350 WATERLOOROAD <br /> LARRY MORGADO <br /> CITY NEAREST CROSS STREET <br /> STOCKTON SIERRA LANE <br /> COUNTY <br /> ^`AILING ADOPSSS SAN JOAQUIN <br /> 525 W. THIRD STREET zip <br /> CITY 95205 <br /> PHONE W!APEA Co3E HANFORD <br /> 209-582-0241 TYRE STATE ZIP <br /> 3UCF SINESS CA <br /> (X) 01 GASOLINE STATION <br /> OF CONTAINERS { ) 02 OTHER 93230 <br /> NU>'8oR <br /> 3 RURAL AREAS ONLY : TOWNSHIP <br /> RANGE <br /> SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAPS: ::ST NAME `:=ST) AND W-A;r0%'— o <br /> MCCUTCF`cti, ,�;M RE <br /> A cc�E <br /> 209-582-0241 NIGHTS: NAME(LAST NAME FIRST) AND PHONE SHIFT SUPERVISOR W,AREA CODE <br /> 209-582-0246 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X1 01 TANK ( 1 C4 OTHER: <br /> CONTAINER NUMBER _, <br /> B_ MANUFACTURER (IF APPROPRIATE): <br /> YEAR MFG: C. YEAR INSTALLED 1959 <br /> ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 SALIS f ) UNKNOWN E. DOES THE CONTAINER STORE: [ ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTORS VEILE FUEL OR WASTE OIL 7 (X! 01 YES ( ) 02 NO <br /> (X) O1 UNLEADED ( ) 02 REGULAR 03 PREMIUM [ ) 04 DIESEL [ ) 45 WASTE OIL {I) YESOCHERK APPROPRIATE BOX(ES): <br /> V CONTAINER CONSTRUCT) <br /> A. THICKNESS OF PRIMARY CONTAINMEN125 ( ) GAUGE (X) INCHES <br /> ( ) CM ( ) UNKNOWN <br /> B. ( 1 O1 VAULTED (LOCATED IN AN UPOUND VAULT) (X) 02 NON—VAULTED ( ! 03 UNKNOWN <br /> C. t ] O1 DOUBLE WALLED (X) 02 SIVALLED ( ) 03 LINED <br /> O. (X) 01 CARBON STEEL ( ) 02 STASTEEL f 1 03 FIBERGLASS ( [ 1 a5 CONCRETE <br /> ( ! 06 ALUMINUM { l 07 STETEF�r ( ) 08 BRONZE f ) 09 COMPO) 04 POLYVINYL CHLORIDE <br /> SITE ( ) 10 MON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER <br /> HSC04-070185 (10/18/85) <br /> PAGE 1 <br />