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• • STATE ID NUMBER 00000036871005 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 1. 4 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> SAN JOAQUIN COUNTY R6%6;8-bd" ( ) 01 FED ( ) 02 STATE &V-03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> E, I � r► STOCKTON CA 952(�Z <br /> V✓ <br /> II FACILITY <br /> :� f lore . C <br /> FACILITY NAME � EALER/FOREMAN/SUPERVISOR <br /> R PETE LA PIESTO j Houn,� lxcv 5l E' l50f <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1810 E HAZELTON <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95201 <br /> MAILING ADDRESS CITY STATE ZIP <br /> P.O. BOX 1810 STOCKTON CA 95201 <br /> PHONE W/AP.EA CCOE TYPE OF BUSINESS <br /> 209-944-2291 ( ) 01 GASOLINE STATION (X) 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 5 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LASTMR FIRST) AND PHONE W/AREA CODE NIGHTSy:�.NAME(LAST NAME FIRST) AND PHONE WfAREA CODE <br /> PE'TL- LA PIESTO, Ve_4 209-944-2291 -SAPIE .�,har+ l <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: /900 GALLONS UNKNOWN JE. DOES THE CONTAINER STORE: (X) 01 WASTE ( ) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( l 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: ( ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (r'02 NON-VAULTED ( 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED USG 02 SINGLE WALLED ( ) 03 LINED <br /> D. (ltf 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> fir( l 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE t ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />