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• STATE ID NUMBER 00000044352003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) <br /> 01 NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE1 <br /> ( 1 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPORATION,INDIVIOUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> RAYMOND INVESTMENT CORPORATION ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 817 S. CENTER ST. STOCKTON CA 95206 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> PROPERTY HELD FOR RENTAL <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 145 N. GRANT ST. WEBER AVE. <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95202 <br /> M4ILING ADDRESS CITY STATE Zip <br /> P.O. BOX 567 STOCKTON CA 95201 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-466-8604 ( ) 01 GASOLINE STATION (X) 02 OTHER <br /> NU)13EP OF CONTAINERS PUPAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 11 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NA MEfLAST NAME FIRST) AND PHONE W/AREA CODE _Tl <br /> IGHTS: NAME(LAST NAME FIRST) ANO PHONE W/AREA CODE <br /> RAYMOND, W.V. 209-466-8604 RAYMOND, W.V. 209-951-7792 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 1111 <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D.. CONTAINER CAPACITY: 500 GALLONS f 1 UNKNOWN TF. DOES THE CONTAINER STORE: f ) 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 /> fXl 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL f ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f ) GAUGE [ ) INCHES ( 1 CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. f ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( 1 03 LINED <br /> D. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> ( ) 06 ALUMINUM f ) 07 STEEL CLAD f 1 08 BRONZE ( ] 09 COMPOSITE f 1 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( l 13 OTHER: <br /> HSC04-070185 (10/18/851 PA-,E 1 <br /> � i <br />