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STATE ID NUMBER 00000012789002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> f 1 01 NEW P€RMIT [ ) 05 RENEWED PERMIT ( 1 07 TANK CLOSED ®) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARG= <br /> I OWNER <br /> NAME(CORPOPATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> MAR LOWE PROPERTIES ( ) 01 FED ( ) 02 STATE ( 1 03 LOCAL <br /> sTReer ADDRESS CITY STATE ZIP <br /> P.O. BOX 211 SAN RAFAEL CA 94915 <br /> II FACILITY <br /> FACILITY NAME <br /> DEALER/FOREMAN/SUPERVISOR <br /> LAURA SCUDDERS DONALD BOLLINGER <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 4640 WATERLOO RD HIWAY 99 <br /> CITY <br /> COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95205 <br /> MAILIN^u ADDRESS CITY STATE IIP <br /> 4640 WATERLOO RD STOCKTON CA 95205.. <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-931-5919 I ] 01 GASOLINE STATION (X1 02 OTHER SNACK FOOD <br /> NUMBER OF CONTAINERS RU P.AL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 2 <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 /> BOLLINGER DONALD 209-ten'-13e9,Ct _ SAME _yg./_ <br /> COMPLETE 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): YEAR MFG: C. YEAR INSTALLED 1980 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 500 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( 7 01 WASTE (X) 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 /> (X) 01 UNLEADED ( ) 02 REGULAR ( 1 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( 1 08 BRONZE ( ) 09 COMPOSITE ( 1 30 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) <br /> PAGE 1 <br />