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STATE ID NUMBER 00000005986001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) <br /> 01 NEW PERMIT t l 05 RENEWED PERMIT [ l 07 TANK CLOSED <br /> ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( 1 G2 CONDITIONAL PERMIT ( l 06 AME14DED PERMIT i 1 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> EPUBLIC AGENCY ONLY <br /> NAM:{ PORATION,!NnIVIDUAL OR PUBLIC AGENCY) l FED ( 1 02 STATE 03 LOCAL <br /> CITY STATE ZIP <br /> sTAEET ADD=ESS STOCKTON GA 95205 <br /> 4040 E. MAIN STR. <br /> II FACILITY <br /> DEALER/FOREMAN/SUPEPVISOP <br /> ACIL-ITY NA''E <br /> BLUE STAR ABDUL GHAFOOR <br /> NEAREST CROSS STREET <br /> STPE-c- =ODPESS ORO <br /> 4040 E. MAIN STP.. <br /> COUNTY ZIP <br /> CITY SAN JOAQUIN 95205 <br /> STOCKTON <br /> CITY TCA <br /> TE PIP <br /> MAILING ADDRESS STOCKTON 95205 <br /> 4040 E. MAIN STR. <br /> PHONE W/AREA CCOE TYPE OF BUSINESS <br /> 209-462-0124 (X) 01 GASOLINE STATION ( ) 02 OTHER <br /> NUMBER. OF CONTAINERS <br /> RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> I <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAPS: NAMECLA5T NAME F_F.ST1 AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CORE <br /> 209-462-0124 <br /> 209-462-0124 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION - <br /> A. (X) 01 TANK t 1 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 6000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 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 /> (X) 01 UNLEADED C ) 02 REGULAR ( ) 03 PREMIUM ( 1 04 DIESEL ( ) 05 WASTE OIL t 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1/4 [ ) GAUGE (X) INCHES [ ) CM [ 1 UNKNOWN <br /> B. ( 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( 1 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. i l 01 DOUBLE WALLED (X) 02 SINGLE WALLED t l 03 LINED <br /> 0. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> f ) 06 ALUMINUM ( ) 07 STEEL CLAD [ ) 08 BRONZE ( ) 09 COMPOSITE ( 1 10 NON-METALLIC <br /> i ) 12 UNKNOWN [ 1 13 OTHER: <br /> PAGE I <br /> HSC04-070185 (10/18/85) <br />