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• • STATE I0 NUMBER 00000002918011 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> (,V-P1 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COP.POPATION,INOIVIDUAL OR PUBLIC AGENCY) (//c 1�0 PUBLIC AGENCY ONLY <br /> 3OReW CALIFORNIA/DEPARTMENT 0 r jvyr(ti syn/' _ ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> CITY STATE ZIP <br /> STREET ADDRESS - - - <br /> 1600 9TH STREET SACRAMENTO CA 95814 <br /> II FACILITY <br /> FACILITY NAME �� ;15TOCKTON <br /> FOREMAN/SUPERVISOR <br /> STOCKTO <br /> STREET ADDRESS CPCSS STREET <br /> 510 EAST MAGNOLIA <br /> ZIP <br /> CITY QUIN 95202 <br /> STOCKTON <br /> MAILING ADDRESS STATE ZIP <br /> 510 EAST MAGNOLIA CA 95202 <br /> FHCNE W/A P.EA CODE TYPE OF BUSINESS <br /> 209-948-7411 ( l O1 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: N>ME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> HINYARD> DARRELL 209-948-7412 HINYARO, 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 11 <br /> B. MANUFACTURER (IF APPROPRIATE): UNK YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 GALLONS ( 1 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 /> (X) 01 UNLEADED f l 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ] 05 WASTE OIL [ 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( 7 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. (' ) O1 DOUBLE WALLED f ) 02 SINGLE WALLED ( 1 03 LINED <br /> D. l7x I CARBON STEEL ( 7 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( l 04 POLYVINYL CHLORIDE f 7 05 CONCRETE <br /> �C ) 06 ALUMINUM ( 1 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( l 10 NON-METALLIC <br /> f ) 13 OTHER: <br /> PAGE 1 <br /> HSC04-070185 (10/18/85) <br />