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• • STATE ID NUMBER 00000002918010 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> t24 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 000r02 CONDITIONAL PERMIT f ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER ( /' <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) ` S PUBLIC AGENCY ONLY <br /> AINWARW CALIFORNIA/DEPARTMENT T)ejjfjfipjqjAA k2,4d ( ) 01 FED ( ) 02 STATE f 1 03 LOCAL <br /> STREET ADDRESS CITY STATE IIP <br /> 1600 9TH STREET SACRAMENTO CA 95814 <br /> II FACILITY <br /> DEALER/FOREMAN/SUPERVISOR <br /> FACILITY NAME C �� J..j._. A ' P ,. <br /> STOCKTON �'� �B✓� �4( �� A�'"'� l ✓ � 'V <br /> STREET ADDRESS NEAREST CROSS STREET <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 /> NUMBER. 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 10 <br /> B. MANUFACTURER (IF APPROPRIATE): UNK YEAR MFG: C .YEAR INSTALLED (X) UNKNOWN <br /> 0. CONTAINER CAPACITY: 10000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( 1 04 DIESEL ( ) 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> M, <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f 1 GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. f 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( ) 03 LINED <br /> D. ( ) 01 CARBON STEEL ( 1 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> � (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />