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• • STATE ID NUMBER 00000036871002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> `f <br /> 01 NEW PERMIT t ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> [�Z CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> S N JOAQUIN COUNTY 01 FED ( l 02 STATE LK-) 03 LOCAL <br /> STREET ADDRESS `- / CITY STATE ZIP <br /> Z E. 1✓e.be(- STOCKTON CA 9520 z <br /> II FACILITY <br /> FACILITY NAME `�, -- j ctyK7'A y!A �44ALER/FOREMAN/SUPERVISOR <br /> PETE LA PIESTO M {A. C ✓ <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1810 E HAZELTON SEl** TRE TAVO <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 45201 <br /> MAILING ADDRESS CITY STATE ZIP <br /> P.O. BOX 1810 STOCKTON CA 95201 <br /> PHONE W/AREA CODE TYPE OF BUSINISS I <br /> 209-944-2291 ( l 01 GASOLNE STATION (X) 02 OTHER Co r W• Y <br /> NUMBER OF CONTAINERSRURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 5 <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 /> RE#f+ LA PIESTO 209-944-2291 <br /> COMPLETE T14E 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 UNKNOWN <br /> D. CONTAINER CAPACITY: GALLONS ( l UNKNOWN E. DOES THE CONTAINER STORE: t l 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 ( ) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES { 1 CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) W 02 NON-VAULTED jXC 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED 02 SINGLE WALLED t l 03 LINED <br /> D. (fid 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( l 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> "" r) 06 ALUMIMJM ( l 07 STEEL CLAD ( l 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> LXr 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />