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STATE ID NUMBER 00000013166002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> NU 01 NEW PERMIT ( 1 05 RENEWED PERMIT f 1 07 TANK CLOSED ( 1 09 DELETE FROM FILE (NO FEE) <br /> ( ) OfTIONAL PERMIT ( ) 06 AMENDED PERMIT ( l 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NA.ME(COPPORATICN,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> J.G. SHAUGHNESSY [ ) 01 FED ( ) 02 STATE [ ) 03 LOCAL <br /> STREET ADDaESS CITY STATE2IP <br /> 601 EAST MINER AVE STOCKTON CA 95202 <br /> II FACILITY <br /> FACILITY N.A'1E DEALER/FOREMAN/SUPERVISOR <br /> SHAUGHNESSY'S CAR WASH SHELL OIL <br /> STPEET ADORESS NEAREST CROSS STREET <br /> 601 EAST MINER AVE AMERICAN <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95202 <br /> MAILING .ADDRE'SS CITY STATE ZIP <br /> 601 EAST MINER AVE STOCKTON CA 95202 <br /> PHONE W/A?EA CODE TYPE OF BUSINESS <br /> 209-465-2542 (X) 01 GASOLINE STATION ( ) 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/.AREA CODE NIGHTS: NAME(LAST NAME FIRST) ANDPHONE W/APE.A 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 [ l 04 OTHER: CONTAINER NUMBER 03 <br /> B. MANUFACTURER (IF APPROPRIATE): N/A YEAR MFG- C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: ;0�+ (� GALLONS (X) 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 ( 1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( 1 02 REGULAR 0 PREMIUM ] 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION -+P4,e^A1 0 <br /> A. THICKNESS OF PRIMARY CONTAINMENT: [ l GAUGE ( l INCHES ( I CM (X) UNKNOWN <br /> B_ ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( 1 02 SINGLE WALLED ( ) 03 LINED <br /> D. [ 1 01 CARBON STEEL ( 102 STAINLESS STEEL ( 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD [ l 08 BRONZE f l 09 COMPOSITE ( l 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070165 (10/18/85) PAGE 1 <br />