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0 <br /> STATE ID NUMBER 00000064319001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 14 01 NEW PERMIT t ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED t l 09 DELETE FROM FILE (NO FEE) <br /> 02 CONDITIONAL PERMIT ( J 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPOP.ATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> QUENTIN 0. KIRSCH ( J 01 FED t ) 02 STATE f ) 03 LOCAL <br /> STREET ADDRESS CITY [CA <br /> TATE ZIP <br /> 190 E. AMBER WAY HANFORD 93230 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> BEACON CAROLOCK STATION #610 J.L.MCCUTCHEN <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 3300 WATERLOO ROAD REPORT AVE. <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95205 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 525 WEST THIRD STREET IIHAN17ORD CA 93230 <br /> RHONE W/AREA CODE TYPE OF BUSINESS <br /> 204-5$2-0241 (X) 01 GASOLINE STATION ( ) 02 OTHER <br /> NUMBER ;OF CONTAINERS RURAL AREAS ONLY :T <br /> OWNSHIP 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 /> MCCUTCHEN) JIM 209-582-0241 SHIFT SUPERVISOR 209-582-0246 <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?: YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS{ D UNKNOWN JE. DOES THE CONTAINER STORE: t ) 01 WASTE (X) 02 PRODUCT. <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES t ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> i J 01 UNLEADED t l" 02 REGULAR t J 03 PREMIUM (X) 04 DIESEL ( J 05 WASTE OIL t J 06 OTHER <br /> a <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY=CONTAINMENT= .025 E l GAUGE (X) 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 ( ) 03 LINED <br /> D. fX) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> t ) 06 ALUMINUM f l 07 STEEL CLAD ( ) 08 BRONZE t 7 '09 COMPOSITE f J 10 NON—METALLIC <br /> t ) 12 UNKNOWN t ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 3 <br /> 4 ., <br />