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��� • • STATE ID NUMBER 00000002918006 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 1 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPOP.ATION,INDIVIDUAL OR PUBLIC AGENCY) S;rRU)c ENCY ONLY <br /> CALI FORNIA/DEPARTMENT 0f ��✓FriW ,^yam/ ( ) D1 FED ( 1 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 1600 9TH STREET SACRAMENTO CA 95814 <br /> II FACILITY /� <br /> FACILITY NAME DZ VPrIopAA L G('1ti�G.G DEALER/FOREMAN/SUPERY�ISOR . <br /> f1i1RR Il A' <br /> STOCKTON <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 510 EAST MAGNOLIA <br /> CITY COUNTY IF <br /> STOCKTON SAN JOAQUIN 95202 <br /> MAILING ADDRESSCITY STATE ZIP <br /> 510 EAST MAGNOLIA STOCKTON CA 95202 <br /> PHONE W/AREA CODE TYPEOF BUSINESS <br /> 209-948-7411 ( ) 01 GASOLINE STATION (X) 02 OTHER STATE HOSPITAL <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> 13 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAMEILAST NAME FIRST) AND PHONE W/AREA CODE - <br /> NIGHTS; NAME(IAST NAME FIRST) AND PHONE W/A P.EA 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 ( ) 04 OTHER: CONTAINER NUMBER 6 <br /> B. MANUFACTURER (IF APPROPRIATE): UNK YEAR MFG: I C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS ( 1 UNKNOWN E. 0EES .T'HEE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? r�.C' U YES _(29-92 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> [ 1 01 UNLEADED f ] 02 REGULAR ( ) 03 PREMIUMK�f 04DIESEL ( 1 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION J <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1/4 ( 1 GAUGE (X) INCHES i ] CM ( ) UNKNOWN <br /> B. ( 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( 1 03 UNKNOWN <br /> C. [ ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( 1 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL f 1 03 FIBERGLASS f 1 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( l 07 STEEL CLAD [ 1 08 BRONZE ( 1 09 COMPOSITE ( 1 10 NON-METALLIC <br /> ( 1 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />