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STATE ID NUMBER <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> tX NEW PERMIT ( 1 05 RENEWED PERMIT t D 07 TANK CLOSED t ) 09 DELETE FROM FILE (NO FEED <br /> t ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> OWNER ' <br /> Landmark Development <br />:AY.E(COPPORATION.INOIVIOUXL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> Landmark Development t ) 01 FED ( ) 02 STATE t 1 03 LOCAL <br /> STPEET A.00RESS CITY SYA <br /> • 125 Bridge Place, Suite 203 Stockton <br />( I FACILITY <br /> FACILITY NAME DEALER/FOREMENtSUPERVISOR <br /> Econo Lube N' Tune Lessee <br /> STREET ACD'ESS NEA.EST CROSS STREET <br /> 440 Westlane �lammertown <br /> CITY COUNTY ZIP <br /> Stockton 95202 <br /> MAILING ADOPESS CIT ETfA <br /> P.0. Box 2470 Newport Beach C IZIP 9265 <br /> 8 <br /> PHONE W/AVEA CODE TYPE OF BUSYNESS <br /> -714- 851-2259 ( ) 01 GASOLINE STATION (X D o2 OTHER Automotive Service <br /> NUKBER CF CONTAINERS FRURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> onp <br /> III i HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAMECLAST NAME FIRST) AND PHONE W/AREA CODE NYGHTS: NAME(LAST NAME FIRST) AND PN E A CODE <br /> Bell , Larry -714-851-2259 Be 1 , Larry _714 811.- 2 4 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM' FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK t D 02 OTHER: CONTAINER NUMBER N/A <br /> 14EW NEW <br /> B. MANUFACTURER (IF APPROPRIATE): Joor Mfg. YEAR MFG: 87 C. YEAR INSTALLED 87 ( ) UNKNOWN <br /> D. C014TAIIIER CAPACITY: 500 GALLONS t I UNKNOW)( E. DOES THE CONTAINER STORE: (X) 01 WASTE ( ) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? tX1 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES1: <br /> t 1 01 U:tLEAOED ( ) 02 REGULAR t ) 03 PREMIUM ( ) 04 DIESEL (XD 05 WASTE OIL t -D 06 OTHER <br /> V CONTAINER CONSTRUCTION . <br /> A. THICY,NESS OF PP•IMARY CONTAINMENT: 12 (XX GAUGE ( ) INCHES ( ) CM ( ) UNKNOWN <br /> B. t D 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. lv01 DOUBLE WALLED t ) 02 SINGLE WALLED ( ) 03 LINED <br /> D. (, 01 CARBON STEEL ( D 02 STAINLESS STEEL ( D 03 FIBERGLASS ( D 04. POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE t ) 09 COMPOSITE t D 10 NON-METALLIC <br /> t 1 12 UNKNOWN (, 1 13 OTHER: <br /> ISC04-0:0185 <br /> PAGE 1 <br />