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• • STATE ID NUMBER 00000046490001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> (N) 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> I'-7 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAM'-(COPPOPATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> HORST HANF I( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS - CITY STATE ZIP <br /> 834 FRANCISCO BLVD. SAN RAFAEL CA 94912 <br /> II FACILITY <br /> Ih <br /> FP.CILITY NAME DEALER/FOREMAN/SUPERVI <br /> TIKI LAGUN RESORT AND MARINA RiWFFhM)'= °`"^ MANAGER I1. Ve,+4" <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 12988 W. MC DONALD RD. NEUGEBAUER RD. <br /> CITY COUNTY IF <br /> STOCKTON SAN JOAgUIN 95206 <br /> MAILING ADDRESS CITY. STATE ZIP <br /> 12988 W. MC DONALD RD. STOC ON CA 95206 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-941-8975 ( ) 01 GASOLINE STATION (X) 02 OTHER MARINA <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 1 <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 /> WALLACE A. READ 209-941-8975 WALLACE A. READ 209-941-8975 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) Ol TANK ( ) 04 OTHER: CONTAINER NUMBER 11298-1 <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: C. YEAR INSTALLED 1962 f l UNKNOWN <br /> D. CONTAINER CAPACITY: 1980 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( 7 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( l 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL t ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( 1 GAUGE f 1 INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED (X) 02 SINGLE WALLED f ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ] 08 BRONZE ( ) 09 COMPOSITE ( 1 10 NON-METALLIC <br /> ( 1 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />