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• • STATE IO NUMBER 00000028041001 <br /> 7 <br /> APPLICATION FOR PERMIT TO 0 ZA7UNDERGROUND STORAGE TANK <br /> 1. ( 1 01 NEW PERMIT ( ) 05 RENEWED PERMIT lYf'07_TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 1 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( 70-8 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION.INOIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> EAST BAY MUNICIPAL UTILITY DIS ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS. CITY STATE ZIP <br /> 2130 ADELINE STREET ) OAKLAND CA 94607 <br /> II FACILITY / <br /> FACILITY NAME DEALER/FOREMAN/SVPERVISOR c 2-. 2 <br /> STOCKTON CENTER RA+t C)S M ,y(7 <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1804 WEST MAIN LOS ANGELES <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95203 <br /> MAILING ADDRESS CITY STATE ZIP <br /> P.O. BOX 24055 OAKLAND CA 94623 <br /> PHONE W/APEA CODE TYPE OF BUSINESS <br /> 415-835-3000 ( ) 01 GASOLINE STATION (X) 02 OTHER UTILITY <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE^W/AREA CCCE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER plke YDunq <br /> IV DESCRIPTION ) <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 45964-1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: I C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 1.000 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 /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL f ) 05 WASTE OIL f ) 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 ) 02 SINGLE WALLED f 103 LINED <br /> D. 01 CARBON STEEL ( ) 02 STAINlE55 STEEL ( ) 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE f 1 09 COMPOSITE f 1 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( 1 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE I <br /> 0 0 <br />