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• STATE ID NUMBER 00000013166001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> Elf) <br /> IT ( } 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE)02 CONDITIONAL PERMIT f l 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> .1 <br /> I OWNER <br /> N-ME(CORPCRATICN,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> J.C. SHAUGHNESSY ( l 01 FED ( ) 02 STATE A5, 03 LOCAL <br /> STP.'.ET ADDRESS CITY STATE ZIP <br /> 601 EAST MINER AVE STOCKTON CA 45202 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREM.AN/SUPEPVISOR <br /> SHAUGHNESSY'S CAR WASH SHELL OIL <br /> STREET ADCPESS NEAREST CROSS STREET <br /> 601 EAST MINER AVE AMERICAN <br /> CITY COUNTY <br /> ZIP <br /> STOCKTON SAN JOAQUIN 95202 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 601 EAST MINER AVE STOCKTON CA 95202 <br /> PHONE W!AREA CODE =TYXrFBUSINESS <br /> 209-465-2542 GASOLINE STATION ( 1 02 OTHER <br /> NUMBER OF CDNTAINERS RURAL AREAS ONLY TOWNSHIP PA.NGE SECTION <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAIS.' NAME(LAST NAME FIRST) AND PHONE W/ARE.A CODE NIGHTS: NAME( LAST NAME FIRST) AND PHONE W/AREA CODE <br /> SHAUGHNESSY J.C. 209-465-2542 SHAUGHNESSY J.C. 209-957-0740 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: C. YEAR INSTALLED CX) UNKNOWN <br /> 0. CONTAINER CAPACITY: 5000 GALLONS ( 1 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 /> ( ) 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL f 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: i ) GAUGE ( ) INCHES f ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) CX) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED f ) 03 LINED <br /> D. f ) 01 CARBON STEEL ( 1 02 STAINLESS STEEL ( ) 03 FIBERGLASS C l 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 1 07 STEEL CLAD ( 1 08 BRONZE ( 1 09 COMPOSITE ( 1 10 NON-METALLIC <br /> (X) 12 UNKNOWN i 7 13 OTHER: <br /> HSC04-070185 [10/18!85] PAGE 1 <br />