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%owl *401 <br /> STATE ID NUMBER 00000004079003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> O1 NEW PERMIT ( 7 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 1 02 CONDITIONAL PERMIT f ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> r <br /> I OWNER <br /> NAY,E(CORPOPATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> SHELL OIL COMPANY ( ) 01 FED ( 7 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> P. 0. BOX 4848 ANAHEIM CA 92803 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMANS PV <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 3011 W BENJAMIN HOLT <br /> CITY COUNTYIIP <br /> STOCKTON SAN JOAQUIN 95209 <br /> MAILING ADOPESS CITYSTATE IIP <br /> 3011 W BENJAMIN HOLT STOCKTON CA CA 95209 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-477-1703 (X) 01 GASOLINE STATION ( ) 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 4 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LOPT NAME FIRST) AND PHONE W/A EA CODE <br /> LINDE, H.Z_gge 209-477-1703 Z/ <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 (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 8000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: [ ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (XI 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( 1 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1/4 f ) GAUGE (X) INCHES ( ) CM f ) UNKNOWN <br /> B. ( l 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED (X) 02 SINGLE WALLED f 7 03 LINED <br /> D. (X) 01 CARBON STEEL ( l 02 STAINLESS STEEL l ) 03 FIBERGLASS l 1 04 POLYVINYL CHLORIDE f ] 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 7 07 STEEL CLAD f 1 08 BRONZE ( ) 09 COMPOSITE f l 10 NON-METALLIC <br /> ( ) 12 UNKNOWN [ ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> �� ry <br />