Laserfiche WebLink
STATE 10 NUMBER'! <br /> APPLICATION FO ARMIT TO OPERATE UNDERGROA STORAGE TANS('' <br /> �Y.Ol_l1E11_PERMIi - <br /> .05_REHEWED_PLRMIF--+1 1.-A7-XANIL.CL03LU..., - --- .LA--09_DELfIL.f.ROt 1�.1L 'L1N0_.,fEE3_ <br /> �1—) O2 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT 1 ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) :T7) <br /> LIC AGENCY ONLY <br /> Sari Joaquin County 01 FED ( ) 02 STATE (x) 03 LOCAL <br /> STREET ADDRESS CITY STAT[ ZIP <br /> 222 E. Weber Street Stockton CA 95202 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> Micke Grove Park <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 11793 N. Micke Grove Road Armstrong Rd. <br /> CITY <br /> Lodi CSan Joaquin ZIP 95240 <br /> MAILING AODRSS! CITYSTATE ZIP <br /> 4520 W. Eight Mile Rd. Stockton CA 95209 <br /> PHONE W ARIA CODE TYPI OF BUSINESS <br /> 209-9442444 c 01 GASOLINE STATION cX) 02 OTHER Park <br /> NUMBER OF CONTAINER= RURAL ARIAS ONLY : TOWN#HIFRANGE SIC'TxON ., <br /> 2 <br /> 1II 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE N/ARIA CODE NIGHT#: HAMI(LAST NAME FIR#T) AND RHONE M/ARRA CODE <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (XI 01 TANK ( ) 04 OTHER: CONTAINER PAIf'18ER <br /> 8. MANUFACTURER tIF APPROPRIATE)= YEAR MFG: C. YEAR INSTALLED l! UNKNOW <br /> 0. CONTAINER CAPACITY: _- GALLONS S I UNKNOWN JE. DOES THE CONTAINER STORE: I 1 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (XI 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> i ) 01 UNLEADED 1 1 02 REGULAR l 1 03 PREMIUM (-.1 04 DIESEL 1 1 05 WASTE OIL 1 ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1 ) GAUGE [ .) INCHES I ) CM f; ) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULTI (`w) 02 NON—VAULTED f ) 03 UNKNOWN <br /> C. ( I 01 DOUBLE WALLED C; 02 SINGLE WALLED ( f 03 LINED <br /> O, f 01 CARBON STEEL 1102 STAINLESS STEEL { 1 03 FIBERGLASS I ) 04 POLYVINYL CHLORIDE 1 ) 05 CONCRETE <br /> 1 ) 06 ALUMII{UM [ } 07 STEEL CLAD f ) 08 BRONZE I ) 04 COMPOSITE { } 10 NON—METALLIC <br /> 1 12 UNKNOWN E ) 13 OTHER: <br /> HSC04—"-4185- 110/18/85) PAGE 1 <br />