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STATE IiMBER 00000018453004 <br /> RATE 'UNDERGROUND .STORAGF TANK , <br /> APPLICATION FOR PERMIT TO OPE „{ .) 09 DELETE FROM FILE, tNO FEE) <br /> ( ) 05 RENEWED PERM IT <br /> i ) 07 TANK CLOSED , <br /> P <br /> ER ( ) 08 MINOR CHANGE (NO SURCHARGE) ' <br /> ITIONAL PERMIT ( ) Ob AMENDED PERMIT # <br /> eti <br /> LPUBLIC AGENCY ONLY 03 LOCAL <br /> { ) O1 FED ( ) 02 STATE t ) <br /> ^4.INCCjVjDUAL OF PUBLIC AGENCY) a <br /> LE 1 INC. STATE ZIP <br /> CITY CA- 45203 <br /> STOCKTON <br /> SS ` ,t <br /> fDEALER/FOREMAN/SUPER\VISOR ' <br /> OIJM IHC. STPEET” <br /> - <br /> NEAREST CP.OS5 <br /> =Ss f/ ZIQ <br /> COUNTY 95203 „_-._... <br /> SAN JOAgUIN <br /> STATE ZIP <br /> CITY:' CA 95201 <br /> STOCKTON -- <br /> 4 <br /> TY=E OF 5USIN£SS . . <br /> EA cOOE ( ) O1 GASOLINE STATION (X) 02 OTHER WHOLESALE <br /> SECTION .._..___ <br /> i9(-_. , RANGE <br /> PUPAL AREAS ONLY TOWNSHIP <br /> C TAINERS - - <br /> } }UR EMERGENCY CONTACT PERSON - r <br /> NIGHTS' NAMEfLA5T NAME FIRST) AND. PHONC W/AREA,COOE ' <br /> SAME <br /> ,E{LAST NAM`_ FI sT) AND <br /> 4b4Y48Bb AREA ccoE <br /> �`COMP��T <br /> FiE FOEL04fING ON A SEPARATE FORM FOR. EACH CONTAINER <br /> SSR I P T 101 N <br /> CONTAINER NUMBER 4 <br /> �1 TANK ( ] 04 OTHER: YEAR INSTALLED 1975 ( ) UNKNOWN <br /> YEAR MFG: <br /> FALRER (IF APPROPRIATE): <br /> E, DOES THE CONTAINER STORE- ( ) O1 WASTE tX) d2 PRODUCT ATfSiOX(E53: <br />'AIT ;R CAPACITY: 12000 GALLONS ( ) UT{lCNO4JN IF TES CHECK APPROPRI — I <br /> { ) D2 NO <br /> F OIL ? (Et t ) OS WASTE OIL t ) d6 ETHER <br /> T CONTAINER STORE MOT VEHICLE FUEL OR )TASTE OIL SF) O1 YES <br /> 01 UNLEADED ( ] 02 REGULAR t ) 03 PREMIUM t ) <br />';O ,+TAINER CONSTRUCTION ] tM tx) UNKNOWN <br /> t ) GAUGE ( ] INCHES ( e u— <br /> CKI SS OF PRIMARY CONTAINMENT' <br /> —bw tX) 02 NON-VAULTED t ] 03 UNKNOWN <br />') Ol AN UNDERGROUND VAULT) <br /> VAULTED )LOCATED IN 4 t <br /> `- <br /> 1 "' <br /> DOUBLE 14ALLEO [ ) 02 SINGLE WALLED ( ) <br /> 03 LINED <br /> CONCRETE <br /> EL l ) 02 STAINLESS STEEL ( ) 03 <br /> FIBERGLASS <br /> OMPO5I04 T£ P4`)V10YNONHMETALLICt ) OS <br />' ) p�, CAP.BOtI 5TE PAGE 1 .. <br />'� 06 ALUttINUM ( ] 07 STEEL CLAD t ) OB BRONZE .[ ) <br />:r) � UNKNOWN ( ) 13 OTHER= <br /> 070185 (10/18/85) <br /> L <br />