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• 0 STATE ID NUMBER 00000012711001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> IL.ai NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 7)) __02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPORATION.INDIVIDUAL OR PUBLIC AGE NC ) PUBLIC AGENCY ONLY <br /> 01 FED ( 1 02 STATE ( ) 03 LOCAL <br /> STREET AOOPESSCITY STATE ZIP <br /> 4800 WATERLOO RD. STOCKTON CA 95205 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPE VISOR <br /> - - Tr( le S , Truck a I ra lu A� enne-4-k Sn ( de,- <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 4800 WATERLOO RD. CHERRYLAND AVE. <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95205 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 4800 WATERLOO RD. STOCKTON CA 95205 <br /> PHONE W/AREA CODE TYPEOF BUSINESS <br /> d3� <br /> 209-9bt ( ) 01 GASOLINE STATION (X) 02 OTHER TRUCKING <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 1 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/APEA CODE NIGHTS: NAME( LAST NAME FIRST) AND PHONE W/AREA COD <br /> �� E <br /> zo9 � °131 -0 ?S ) Roc zo9-s54a3se ail- 075 <br /> 1 LoyveAr\ jn%J� Ke anei , SON, er <br /> COMPLETE THE FOLLOWING ON A SEPARATE RM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 01 <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: C. YEAR INSTALLED 1969 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 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 /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL ( ) 05 WASTE OIL ( l 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( 1 GAUGE ( ) INCHES ( ) CM ( ) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL l ) 02 STAINLESS STEEL f 1 03 FIBERGLASS f 1 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> V--C" ) 06 ALUMINUM f ) 07 STEEL CLAD ( 7 08 BRONZE ( 7 09 COMPOSITE ( 1 10 NON-METALLIC <br /> (g 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />