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F R r • STATE ID NUMBER 00000002916012 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 1 NEW PERMIT <br /> ( ) O5 <br /> RENEWED PERMIT <br /> ( 1 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( 1 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT f l OB MINOR CHANGE (NO SURCHARGEI <br /> I OWNER <br /> PUBLIC AGENCY ONLY <br /> NAME(COPPOPA710N.INDIVTOUAL OR <br /> PUBLIC Qll/B�) 2�/c ( 1 01 FED ( 1 02 STATE ( 1 03 LOCAL <br /> TY STATE ZIP <br /> STREET ADDRESS SACRAMENTO CA 95814 <br /> 1600 9TH STREET <br /> II FACILITY �C p <br /> tSTOCKT0NdNWP"--­- <br /> D <br /> NAME �/� 1-e�/�/' �7y/Z DEALER/FOREMAN/SUPERVISOR <br /> NEAREST CROSS STREET <br /> DRESS <br /> MAGNOLIACOVNTY ZIP SAN JOAQUIN 95202 <br /> CITY STATE ZIP <br /> MAILING ADDRESS STOCKTON CA 95202 <br /> 510 EAST MAGNOLIA <br /> jo:: <br /> AREA CODE TYPE OF BUSINESS <br /> 7411 f ) O1 GASOLINE STATION (X) 02 OTHER STATE HOSPITAL <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP <br /> RANGE SECTION <br /> 13 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/A P.EA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> HINYARDe 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 ( l 04 OTHER: <br /> CONTAINER NUMBER 12 <br /> B. MANUFACTURER (IF APPROPRIATE): UNK YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 500 GALLONS f ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( 1 01 YES (X) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> f 1 <br /> 01 UNLEADED f ) 02 REGULAR ( 1 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( 1 GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) O1 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. )X)(01 CARBON <br /> (( )) STAINLESS <br /> STEEL03 <br /> BRONZEF IBERG09SCOMPOSITE POLYVINYL <br /> 05 CONCRETE <br /> NON-METALLIC <br /> ) <br /> ( 1 12 UNKNOWN ( ) 13 OTHER: <br /> PAGE 1 <br /> HSC04-070185 (10/18/85) <br />