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• • STATE ID NUMBER 00000066587001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 02 CONDITIONAL PERMIT ( 7 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> ( ) 01 FED ( 1 02 STATE 03 LOCAL <br /> PITT-DSS MOINES INC. -- <br /> CITY =CA95201 <br /> ZIP <br /> STREET ADDRESS STOCKTON <br /> 3535 E. MYRTLE STREET <br /> II FACILITY <br /> DEALER/FOREMAN/SUPERVISOR <br /> FACILITY NAME <br /> STOCKTON SERVICE CENTER ROD CAMPBELL <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 3535 E. MYRTLE STREET HWY 99 <br /> COUNTY ZIP <br /> CITY SAN JOAQUIN 95205 <br /> STOCKTON <br /> MAILING ADDRESS CITY STATE ZIP <br /> P.O. BOX 310 STOCKTON CA 95201 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-943-0513 ( ) O1 GASOLINE STATION (X) 02 OTHER STEEL SERVICE CENTER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> 4 <br /> I <br /> III 24 HOUR EMERGENCY CONTACT PERSON C1 <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> CAMPBELL, ROD 209-943-0513 CAMPBELL, ROD 209-477-5664 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 74-1D <br /> B. MANUFACTURER (IF APPROPRIATE): ?????'.'.????'.?'.???'•'•????'??'"•? YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: (X) 01 WASTE ( ) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WAJTJ OIL ? f ) 01 YES ( 7 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> l 1 01 UNLEADED ( 7 02 REGULAR ( 1 03 PREMIUM 04 DIESEL I ) 05 WASTE OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: X ( 1 GAUGE ( 7 INCHES (X) CM ( ) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED ( 7 02 SINGLE WALLED ( ) 03 LINED <br /> D. [ ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 7 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( l 05 CONCRETE <br /> ( ) 06 ALUMINUM f 107 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE l ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( 7 13 OTHER: <br /> PAGE 1 <br /> HSC04-070185 (08/29/86) <br />