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e <br /> • . • • STATE IO NUMBER 00000002918001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> (<}l NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED <br /> 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE)) 09 DELETE FROM FILE (NO FEEL <br /> I OWNER <br /> NAME(CORPORATION,INDIVIOUAL OR PUBLIC AGENCY) <br /> F CALIFORNIA/DEPARTMENT DF /J/!`!/fG0 /U/� JJ G PUBLIC AGENCY ONLY <br /> L V/C� ( 1 01 FED ( 1 02 STATE ( 7 03 LOCAL <br /> STREET ADDRESS <br /> 1600 9TH STREET CITY STATE ZIP <br /> SACRAMENTO CA 95814 <br /> frrI__I FACILITY <br /> FACILITY NAME 370G�('ZyN �JEYG LOrA//f,'N'7`j¢L <br /> DEALER/FOREMAN/SUPERVISOR <br /> C F+✓_762 � � AKR6L L H iiv yf320 <br /> STREET ADDRESS <br /> 510 EAST MAGNOLIA NEAREST CROSS STREET <br /> CITY <br /> STOCKTON COUNTY ZIP <br /> SAN JOAQUIN 95202 <br /> MAILING ADDRESS <br /> 510 EAST MAGNOLIA CITY STATE ZIP <br /> STOCKTON CA 95202 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-948-7411 ( ) 01 GASOLINE STATION (X) 02 OTHER STATE HOSPITAL <br /> NUMBSP OF CONTAINERS RURAL AREAS ONLY TOWNSHIP <br /> 13 RANGE SECTION <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 /> HINYARD> DARRELL 204-948-7412 HINYARD. DARRELL. 209-948-7111 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: <br /> CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): UNK YEAR MFG: <br /> C. YEAR INSTALLED (X) UNKNOWN <br /> 0. 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 ? f ) 01 YES (X) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( 1 01 UNLEADED R ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL <br /> 06 MTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f ) GAUGE f 1 INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) O1 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE f 1 05 CONCRETE. <br /> ( 1 06 ALUMINUM ( ) 07 STEEL CLAD ( 1 08 BRONZE ( J 09 COMPOSITE ( 7 10 NON-METALLIC <br /> ( ) 12 UNKNOWN f ) 13 OTHER: <br /> HSC04-070185 (10/18/85) <br /> PAGE 1 <br /> ) <br />