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• STATE ID NUMBER 09000001219001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> i�/I 01 NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> - 02 CONDITIONAL PERMIT ( ] 06 AMENDED PERMIT ( l OB MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPORATION,INDIVIDUAL OR UBLIC AGENCY) PUBLIC AGENCY ONLY <br /> -BUICK PONTIACe,k�C�y� ( I 01 FED ( ) 02 STATE 03 LOCAL <br /> STREET ADDPESS CITYLSCTA <br /> ATE ZIP <br /> 415 E. MINER STOCKTON 95202 <br /> II FACILITY <br /> FACILITY NAME . �� DEALER/FOPEMAN/SUPERVISOR <br /> D BUICK PONTIAC FRANK DEROLLO <br /> STPEET ADDPESS NEAREST CROSS STREET <br /> 415 E. MINER SUTTER <br /> CITY COUNTY IIP <br /> STOCKTON SAN JOAQUIN 95202 <br /> MAILING ADDPES CITY STATE ZIP <br /> P. 0. BOX ` <br /> STOCKTON CA 9520 <br /> PHONE W/AREA CCOE TYPE OF BUSINESS <br /> 209-946-0220 ( 1 01 GASOLINE STATION (X) 02 OTHER CAR OEALER <br /> NUMBER OF CONTAINERS PUPAL AREAS ONLY TOWNSHIP FANGE SECTION <br /> 1 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AP.EA CODE NIGHTS: N.4ME(LAST NAME FIRST) AND PHONE W/AR€.A CODE <br /> 209-946-0220 _ <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER T-1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: (X) 01 WASTE t ) 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 ( 104 DIESEL (X) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( 1 INCHES ( 1 CM (X) UNKNOWN <br /> B. ( 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( 1 02 NON-VAULTED (X) 03 UNKNOWN <br /> 01 DOUBLE WALLED ( 02 SINGLE WALLED ( ) 03 LINED <br /> D. ( <br /> 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS [ ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> 06 ALUMINUM ( ) 07 STEEL CLAD [ ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> (XI 12 UNKNOWN t ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />