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• STATE ID NUMBER 00000002918009 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ("y 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED <br /> ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> _ l PUBLIC AGENCY ONLY <br /> NAME(COP.P CALIFORNIA/DEPARTMENT PUBLIC AGENCY) <br /> ✓Q U bH Pif/LJR (Y.�„ �/L ( ) 01 FED f 1 02 STATE [ 1 03 LOCAL <br /> // J FCIITY STATE ZIP <br /> STREET ADDRESS SACRAMENTO CA 95814 <br /> 1600 9TH STREET <br /> II FACILITY L� -" /(��y/� <br /> FACILITY NAME �e ✓PiIU/�/Yl?in T/1ti l�•�I�( Y/`+ OEALER/FOREMAN/SUPERVISOR <br /> NEAREST CROSS STREET <br /> STREET ADDRESS <br /> 510 EAST MAGNOLIA <br /> COUNTY ZIP <br /> CITY SAN JOAQUIN 95202 <br /> STOCKTON <br /> rSTOCKTON <br /> STATE ZIP <br /> MAILING ADDRESS CA 95202 <br /> 510 EAST MAGNOLIA <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-948-7411 f ) 01 GASOLINE STATION (X) 02 OTHER STATE HOSPITAL <br /> NUMBER OF CONTAINERS <br /> 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 /> FnMXANUFlACTURER <br /> 0TANK ( 1 04 OTHER: <br /> CONTAINER NUMBER 9 <br /> (IF APPROPRIATE): UNK YEAR MFG C. YEAR INSTALLED {X) UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS f ) UNKNOWN E. DOES THE CONTAINER STORE: ( 1 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( 1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( 1 03 PREMIUM (X) 04 DIESEL ( ) 05 WASTE OIL ( ] 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( 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 ( ] 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X)(0; CARBON6RLUMINUM075TEEL <br /> L ff STAINLESS <br /> STEEL <br /> 08(BRONZEFIBERGLASS <br /> COMPOSIOE POLYVINYLCHLORIDE) lONON-METALLIC( 1 05 CONCRETE <br /> ( ) 12 UNKNOWN ( 1 13 OTHER: <br /> PAGE 1 <br /> HSC04-070185 (10/18/85) <br />