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0 <br /> STATE ID NUMBER 00000063414007. <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> (;(4L 01 NEW PERMIT i ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED I ) 09 DELETE FROM FILE (NO FEE) <br /> t ) 02 CONDITIONAL PERMIT ( l 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> N.AME(CO?POPATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> tps--� o, ( ) 01 FED ( ) 02 STATE' i ) 03 LOCAL <br /> STPEET ADDRESS CITY STATE ZIP <br /> 1756 NO. WILSON WAY STOCKTON CA 95205 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> YARB 1ARKET Am <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1756 NO WILSON WAY BRADFORD <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95205 <br /> MAILING ADDRESS CITY STATE ZIP _ <br /> 7 c STOCKTON CA 9.5 . e?5;3vS <br /> PHONE W/ATEA OOE T PE OF BUSINESS <br /> 209-941-2264 (X) 01 GASOLINE STATION ( ) 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 2 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME( LA T NAME FIRST) AND PHONE W/AREA CODE kIGHTS: NAME(LAST NAME FIRST) AND PHONE W/A EA CODE <br /> wX_"A&ll 19 209�A3�-FC> r SAME <br /> r <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( 1 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): PERKINS YEAR MFG: 1972 C. YEAR INSTALLED 1972 ( ) 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(ES1: <br /> [ ) 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM E ) 04 DIESEL ( ) 05 WASTE OIL i ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1/4 I ) GAUGE (X) INCHES f ] CM ( ) UNKNOWN <br /> B. [ ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED i ) 03 UNKNOWN <br /> C. ( l 01 DOUBLE WALLED (X) 02 SINGLE WALLED t ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( l 02 STAINLESS STEEL [ ) 03 FIBERGLASS i ] 04 POLYVINYL CHLORIDE t ) 05 CONCRETE <br /> t ) 06 ALUMINUM l ) 07 STEEL CLAD ( ) 08 BRONZE ( l 09 COMPOSITE t ) 10 NDN-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />