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%410 STATE ID NUMBER 00000028627002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> O1 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED f 7 09 DELETE FROM FILE (NO FEE) <br /> f l 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT f ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAM!(CORPOPATION.INOIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> GLENN PRICKETT ( ) 01 FED ( 1 02 STATE = 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 3650 E. HUNTINGTON BLVD. FRESNO CA 93704 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> AMERICAN TRANSFER FRED BENTZ <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 2701 S. HIGHWAY 99 MARIPOSA RD. <br /> CITY COUNTY <br /> ZIP <br /> STOCKTON SAN JOAQUIN 95201 <br /> MARINO ADDRESS CITY STATE ZIP <br /> 27,01 S � y'J �.. "7 STOCKTON CA <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-466-0111 ( ) O1 GASOLINE STATION (X) 02 OTHER TRUCKING CO. <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 2 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NZOHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> BENTZ, FRED 209-466-0111 BENTZ> FRED 209-369-0710 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 2 <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: C. YEAR INSTALLED IX) UNKNOWN <br /> D. CONTAINER CAPACITY: ( 1 UNKNOWN E. DOES THE CONTAINER STORE: ( 1 01 WASTE 06 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 f ) 02 REGULAR ( ) 03 PREMIUM (-<) 04 DIESEL ( 1 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( 1 INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( 1 03 LINED <br /> D. (X) 01 CARBON STEEL f ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS t ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> f ) 06 ALUMINUM f ) 07 STEEL CLAD ( 1 08 BRONZE ( 7 09 COMPOSITE ( ) 10 NON-METALLIC <br /> f ) 12 UNKNOWN ( ) 13 OTHER: <br />. HSC04-070185 (10/18/85) PAGE 1 <br /> �� 1l/ <br />