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. • STATE ID NUMBER 00000002918013 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE <br /> TANK <br /> f�vv'O1 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED <br /> ( ) 09 DELETE FROM FILE (NO FEE) <br /> 02 CONDITIONAL PERMIT ( l 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> 5,�..moi/�fj PUBLIC AGENCY ONLY <br /> NAME(CD F.RO F.ATION,IND IVIDUAL OR PUBLIC AGENCY) O1 FED ( 1 02 STATE ( ) 03 LOCAL <br /> *RWSNWCALIFORNIA/DEPARTMENT <br /> CITY STATE ZIP <br /> STREET ADDRESS SACRAMENTO CA 95814 <br /> 1600 9TH STREET _ <br /> II FACILITY / <br /> ,� c.16/�m 7 DEALER/FOREMAN/SUPERYI�Rn�y�L {'L„w ��// <br /> FACILITY NAME r/V �'G //'��+,5 7/ /✓ �'�V �J/ <br /> STOCKTON+ii <br /> NEAREST CROSS STREET <br /> STREET .ADDRESS <br /> 510 EAST MAGNOLIA <br /> ZIP <br /> COUNTY 95202 <br /> CITY SAN JOAQUIN <br /> STOCKTON STATE ZIP <br /> CITY CA 95202 <br /> MAILING ADDRESS STOCKTON <br /> 510 EAST MAGNOLIA <br /> PryON=_ W/.4 REA CODE TYPE OF BUSINESS <br /> ( ) 01 GASOLINE STATION (X) 02 OTHER STATE HOSPITAL <br /> 209-948-7411 <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP <br /> RANGE SECTION <br /> 13 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> D YS' N-MElLAS� NAME FIRST) AND PHONE W/A/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PH�W/AREA CODEHINYARD DARRELL 209 948 7412HINYARO DARRELL 209-948-71 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> CONTAINER NUMBER 13 <br /> FF. DOESGTHE <br /> 01 TANK ( 1 .04 OTHER: <br /> FACTURER (IF APPROPRIATE): UNK YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> AINER CAPACITY: 500 GALLONS f ) UNKNOWN E. DOES THE CONTAINER STORE: (X) 01 WASTE ( 1 02 PRODUCT <br /> IUN LON EAD UNLEADED <br /> ST02ERMo EGUOLARVEH I'LE03F PR PREMIUM U4LDIESEL 0(X)YES 05 WASTE 20 (140 I1 06SOTHER <br /> K APPROPRIATE BOX(ES); <br /> V CONTAINER CONSTRUCTION <br /> F(X) <br /> OF PRIMARY CONTAINMENT: ( ) GAUGE f ) INCHES ( ) CM (X) UNKNOWN <br /> AULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> OUBLE WALLED ( ) 02 SINGLE WALLED ( ) 03 LINED <br /> 6RAOLUMINUML STAINLESS <br /> S(E 1L 08( 03 BRONZEFIBERG09SS 04 COMPOSITE POL)V10YL CHLORIDENON-METALLIC( ) 05 CONCRETE <br /> NKNOWN ( ) 13 OTHER: <br /> PAGE 1 <br /> HSC04-070185 (10/18/85) <br />