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R <br /> STATE ID NUMBER 00000006118004 <br /> APPLICATION FOR PERMIT TOPERATE UNDERGROUND STORAGE TANK <br /> (�6 01 NEW PERMIT ( ) 05 RENEWED PERMIT _M 0 707TAANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 2 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( 1 08.MIR.)FW_CR7%UT(NO SURCHARGE) <br /> I OWNER <br /> NAME(COPFOP.ATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> SHELL OIL COMPANY I _ Zip ( ) 01 FED ( ) 02 STATE t ) 03 LOCAL <br /> ST?E_T ADDRESS CITY STATE ZIP <br /> P.O. BOX 4848 ANAHEIM CA 92803 <br /> II FACILITY <br /> FACILITY NAME ! _ DEALER/FOREMA /SUPERVISOR <br /> // Lz 0 <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 4315 WATERLOO RD. <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95205 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 4315 WATERLOO RD. STOCKTON CA 95205 <br /> PHONE W/APEA CODE TYPE OF BUSINESS <br /> 209-931-3672 (X) 01 GASOLINE STATION ( 1 02 OTHER <br /> NUMBER OFCONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST AND PHONE W/AREA CODE <br /> 209-931-3672 AO - <br /> 1 t-Ii <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 /> -T B. M.At4UFACTUPER (IF APPROPRIATE): UNKNOWN YEAR MFG: C. YEAR INSTALLED 1966 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 550 GALLONS ( ) UNKNOWN JE. DOES THE CONTAINER STORE: (X) 01 WASTE ( l 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 ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL (X) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 12 (X) GAUGE ( ) 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 ( l 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL f ) 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( l 05 CONCRETE <br /> ( ) 06 ALUMINUM ( l 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( l 10 NON-METALLIC <br /> ( l 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />