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STATE ID NUMBER 00000003446001 <br /> r APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> (y 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> L`?`` 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( l 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NA."1=(CC-PCP4TION,IN:IVIOUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> GIBRALTER COMMUNITY BUILDERS ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDPESS CITY STATE ZIP <br /> 5713 N. PERSHING AVENUE STE E STOCKTON CA 95207 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> SADDLE CITY CHEVRON RICHARD BOKIDES <br /> STREET ADDPESS NEAREST CROSS STREET <br /> 6421 W. PADDOCK PLACE HIGHWAY 12 <br /> CITY COUNTY ZIP Z U <br /> LODI SAN JOAQUIN +i <br /> MAILIN3 ADDPESS CITY STATE ZIP <br /> W. PADDOCK PLACE LODI CA 95240 <br /> PHONE W/A.P.EA CODE Tr PE OF BUSINESS <br /> 209-334-0975 (X) 01 GASOLINE STATION ( ) 02 OTHER <br /> JNUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 5 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: N4ME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/.AREA CODE <br /> RICHARD BOKIDES 209_095&m*dm 7,6 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( l 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): ARROW TANK CO. YEAR MFG: 1983 C. YEAR INSTALLED 1983 ' ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 12000 GALLONS ( ) 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 ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> (X) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( l 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> D <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1/4 ( ) GAUGE (X) INCHES ( ) CM ( ) 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 ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( l 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( l 07 STEEL CLAD ( ) 08 BRONZE ( l 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> • <br />