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• • STATE ID NUMBER 00000065015002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ] 01 NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED <br /> ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( 1 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( 1 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> PUBLIC AGENCY ONLY <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) ( ) O1 FED ( 1 02 STATE ( ) 03 LOCAL <br /> CALTRAN <br /> CITY S <br /> STATE ZIP <br /> STREET ADDRESS STOCKTON CA 95205 <br /> 1976 E. CHARTER WAY <br /> II FACILITY <br /> DEALER/FOREMAN/SUPERVISOR <br /> FACILITY NAME RYAN TRIGG <br /> DISCOUNT TIRE <br /> NEAREST CROSS STREET <br /> STREET ADDRESS WASHINGTON <br /> 204 S. WILSON WAY <br /> ZIP <br /> COUNTY 95205 <br /> CITY SAN JOAQUIN <br /> STOCKTON <br /> STATE ZIP <br /> CITY CA 95205 <br /> MAILING ADDRESS STOCKTON <br /> 204 S. WILSON WAY <br /> PHONE W/AREA CODE TYPE OF BUSINESS( ) O1 GASOLINE STATION (X) 02 OTHER TIRE <br /> 209-465-1300 <br /> SECTION <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP <br /> RANGE <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 /> REYBURN. W. 209-948-7860 <br /> MARTIN, G.H. 209-466-4007 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> CONTAINER NUMBER 11503-B <br /> A. (X) 01 TANK ( ) 04 OTHER: <br /> YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> B. MANUFACTURER (IF APPROPRIATE): <br /> D. CONTAINER CAPACITY: 1000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONNER STORE R MOTOR <br /> V FUEt <br /> 04LDIESEL O( )E 05 WASTE 2OIL (Il 06$OTHERK APPROPRIATE BOX(ES): <br /> ( ) O1 UNLEADED <br /> V CONTAINER CONSTRUCTION <br /> PVFOF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES [ ) CM (X) UNKNOWN <br /> LTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> BLE WALLED ( ) 02 SINGLE WALLED [ 1 03 LINED <br /> IDE <br /> BBO(NjMITEEL (( ))002SSTAINLESSS(EEL08BRONZE03 FIBERG09SS 04 COMPOSITE Pt )V10YNON-METALLIC( 105 CONCRETE <br /> NUM <br /> TEEL CLAD <br /> NOWN ( ) 13 OTHER: PAGE 1 <br /> HSC04-070185 (07/03/87) <br />