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STATE ID NUMBER 00000002918008 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> f/ 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPOPATION,:NDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> &V'E1►CALIFORNIA/DEPARTMENT QG e✓/4 Sen e/ce ( ) 01 FED ( l 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 1600 9TH STREET SACRAMENTO CA 95814 <br /> II FACILITY <br /> FACILITY NAME oe✓y�(/a/� L DEALER/FOREMAN/SUPERVISOR <br /> STOCKTON 9.T"- llfF1'7*L���i <br /> STREET ADDRESS NEAREST CROSS STREIr <br /> 510 EAST MAGNOLIA <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95202 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 510 EAST MAGNOLIA STOCKTON CA 95202 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-948-7411 ( ) 01 GASOLINE STATION (X) 02 OTHER STATE HOSPITAL <br /> NUMB-; 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 ( ) 04 OTHER: CONTAINER NUMBER 8 <br /> B. MANUFACTURER (IF APPROPRIATE): UNK YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS ( l UNKNOWN E. DOES THE CONTAINER STORE: f ) 01 WASTE IX) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE IL ?�1 YES jm;f.02 NO IF YES CHECK APPROPRIATE BOXIEST: <br /> ( 1 01 UNLEADED ( ) 02 REGULAR f ) 03 PREMIUM 6D4 DIESEL f 1 05 WASTE OIL f 1 06 OTHER <br /> V CONTAINER CONSTRUCTION 7 <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1/4 ( ' ) GAUGE ( 1 INCHES ( ) CM ( ) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL f ) 03 FIBERGLASS f l 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM . ( 1 07 STEEL CLAD ( ) 08 BRONZE f 1 09 COMPOSITE f ) 10 NON-METALLIC <br /> ( 1 12 UNKNOYM ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />