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STATE ID NUMBER 00000002918005 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> (aj1 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COEPORATION.INDIVIDUAL OR PUBLIC AGENCY) _ � / PUBLIC AGENCY ONLY <br /> CALIFORNIA/DEPARTMENT 4F Q��f7 aY(IYN�- ��C� f 7 01 FED [ ) 02 STATE ( 103 LOCAL <br /> STPEET ADOPESS CITY STATE ZIP <br /> 1600 9TH STREET SACRAMENTO CA 95814 <br /> II FACILITY / /_ p� <br /> FACILITY NAME F'/✓Q/U�7�`1 P/LLT'7�G G'wFv �'G'1w- DEALER/FOPEMAN/SUPERVISOR <br /> STOCKTO _ <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 510 EAST MAGNOLIA <br /> CITY COUNTY ZIp <br /> STOCKTON SAN JOAQUIN 95202 <br /> MAIL:N3 ADDRESS CITY STATE ZIP <br /> 510 EAST MAGNOLIA - STOCKTON CA 95202 <br /> PHONE WIAREA CODE TYPE OF BUSINESS <br /> 209-948-7411 ( ) 01 GASOLINE STATION (X1 02 OTHER STATE HOSPITAL <br /> N'JMBEP OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> 13 <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 5 <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: f ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE L ? S44 <br /> YES �2 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ! ) 01 UNLEADED ( ) 02 REGULAR f ) 03 PREMIUM 4 DIE EL f 1 0 ASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1/4 ( ) GAUGE (X) INCHES ( ) CM ( ) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( l 01 DOUBLE WALLED (X) 02 SINGLE WALLED [ ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 7 07 STEEL CLAD ( ) 08 BRONZE ( 1 09 COMPOSITE ( ) 30 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> • <br /> 1 <br />