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STATE ID NUMBER 00000023486003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> V) O12 <br /> NEW PERMIT l 1 05 RENEWED PERMIT ( 1 07 TANK CLOSED ( 1 09 DELETE FROM FILE (NO FEE) <br /> CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( 1 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> N4ME(COPPOPATION,INDIVIDUAL OR PUBLIC AGENCY? PUBLIC AGENCY ONLY <br /> JIM & MARY CATALINE ( ) 01 FED ( 1 02 STATE ( ) 03 LOCAL <br /> STREET AODAESS CITY STATE ZIP <br /> 19812 E. GAWNE RD. STOCKTON CA 95205 <br /> II FACILITY <br /> FACiLIT'Y N<^'_ <br /> e DEALER/FOREMAN/S ERVISOR In <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1405 MAIN ST. <br /> CITY COUNTY ZIP <br /> ESCALON ISAN JOAQUIN 95320 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 1405 MAIN ST. ESCALON CA 95320 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-838-7621 (X) 01 GASOLINE STATION f ! 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: N,AME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAMEiLAST N4."9E FIRST) AND PHONE W/AREA CODE <br /> CATALINE JIM 209-838-7546 SAME - <br /> _._ WLj ' <br /> COMPLE E THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( 1 04 OTHER: CONTAINER NUMBER 2 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1959Fc, YEAR INSTALLED 1959 ( ) UNKNOWN <br /> 0. CONTAINER CAPACITY: 6000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: f ) 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 /> t 1 01 UNLEADED i ) 02 REGULAR ( 1 03 PREMIUM (X) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( 1 CH (X) UNKNOWN <br /> B. ( 101 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( 1 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED ( 1 02 SINGLE WALLED ( ) 03 LINED <br /> D. ('X'P 01 CARBON STEEL ( l 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( 1 09 COMPOSITE l ) 10 NDN-METALLIC <br /> ] 12 UNKNOWN ( ) 13 OTHER: <br /> PAGE 1 <br /> HSC04-070185 (10/18/85) <br />