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y <br /> • • STATE ID NUMBER 00000002918004 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> X* 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( 1 09 DELETE FROM FILE (NO FEE) <br /> TT�a2 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> tNAME(COPPORATION,INDXVIDUAL OR PUBLIC AGENCY) <br /> CALIFORNIA/DEPARTMENT "' PUBLIC AGENCY ONLY <br /> of deve(o Py«MG S%.LO/G� ( 1 01 FED ( J 02 STATE ( J 03 LOCAL <br /> DRESSSTREET CITY - STATE IIP <br /> SACRAMENTO CA 95814 <br /> II FACILITY <br /> FFACIL:-.y NAME DEALER/FOREMAN/SUPERVISOR �H <br /> N Giiw ADDRESST MAGNOLIA NEAREST CROSS STREETN COUNTY IIP <br /> SAN JOAQUI14 95202 <br /> MAILING ADDRESS <br /> CITY <br /> 510 EAST MAGNOLIA STATE IIP <br /> STOCKTON CA 95202 <br /> PHONE W/AREA CODE TEONLY <br /> S <br /> 209-948-7411 E STATION (X) 02 OTHER STATE HOSPITAL <br /> NUMBER. OF CONTAINERS RURAL AOWNSHIP RANGE <br /> 13 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 209-948-7412 HINYARD, DARRELL 209-948-7111 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( 1 04 OTHER: CONTAINER NUMBER 4 <br /> B. MANUFACTURER (IF APPROPRIATE): PERKINS YEAR MFG 1972 C. YEAR INSTALLED 1972 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS ( 1 UNKNOWN E. DOES THE CONTAINER STORE: ( ] 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ?�1 YES 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) <br /> 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM Wf 04 DIESEL L ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> n <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1/4 ( 7 GAUGE (X) INCHES ( ) CM ( ) 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 ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( 1 09 COMPOSITE [ 1 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/851 <br /> PAGE 1 <br />