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• • STATE ID NUMBER 00000035194t <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED <br /> l ) 09 DELETE FROM FILE (NO FE! <br /> ( 1 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( 1 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> PUBLIC AGENCY ONLY <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) ( ) 01 FED ( ) 02 STATE x 03 LOCAL <br /> VAN & BOB' S INC. <br /> CITY STATE ZIP <br /> STREET ADDRESS STOCKTON CA 95204 <br /> 45 E. HARDING WAY <br /> II FACILITY <br /> DEALER/FOREMAN/SUPERVISOR <br /> FACILITY NAME WALLY LEE <br /> WALLY'S CHEVRON <br /> NEAREST CROSS STREET <br /> STREET ADDRESS 8TH ST. <br /> 2088 MARIPOSA RD <br /> COUNTY ZIP <br /> CITY SAN JOAQUIN 95205 <br /> STOCKTON <br /> CITY STATE ZIP <br /> MAILING ADDRESS STOCKTON CA 95205 <br /> 2088 MARIPOSA RD <br /> F209-465-6825 <br /> /AREA COLE TYPE OF BUSINESS <br /> (X1 O1 GASOLINE STATION ( 1 02 OTHER== <br /> OF C�'TAINERS <br /> RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND-PHONE W/AREA CODE <br /> WALLY LEE 209-465-6825 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> EMANUFACTURER <br /> E EAPPROPRIATE): <br /> ER: CONTAINER NUMBER 1 <br /> YEAR MFG: C. YEAR INSTALLED 1975 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 5000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( 1 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINERXSTORE <br /> ERMOTOR VEHICLE FUEL ORMDIESEL ( ) 06 <br /> WASTE OIL0E05 ( ) 02 <br /> 20IO IIF YES <br /> SOCHECK APPROPRIATE BOX(ES): <br /> O <br /> V CONTAINER CONSTRUCTION <br /> rA. THICKNESS OF PRIMARY CONTAINMENT: ( 1 GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> X) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( 1 02 NON-VAULTED ( ) 03 UNKNOWN <br /> ) O1 DOUBLE WALLED ( 1 02 SINGLE WALLED ( ) 03 LINED <br /> p, I Z O1 CARBON STEEL [ ) 02 STAINLESS STEEL ( 103 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> rt+( ) 06) p6 ALU ( 107 STEEL CLAD ( F 08 BRONZE f 1 09 COMPOSITE ( 1 10 NON-METALLIC <br /> ��T ) 13 OTHER: <br /> PAGE I <br /> HSC04-070185 (10/18/85) <br />