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STATE ID NUMBER 00000064319002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 01 NEW PERMIT t l 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE ENO FEE) <br /> ( l 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I _OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGE-NCY) PUBLIC AGENCY ONLY <br /> QUENTIN D. KIRSCH t ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> --] <br /> STREET ADDRESS CITY STATE ZIP <br /> 190 E. AMBER WAY HANFORD CA 93230 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> BEACC14 CARDLOCK 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 HANFORO CA 93230 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-582-0241 (X) 01 GASOLINE STATION ( ) 02 OTHER <br /> NUMBER OF C NTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AR-EA CODE NIGHTS: 'NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> MCCUTCHEN: JIM 209-582-0+241 SHIFT SUPERVISOR 209-582-0246 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( D 04 OTHER: CONTAINER NUMBER <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS t ) UNKNOWN E. DOES THE CONTAINER STORE: t ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL T (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> t ) 01 UNLEADED (X) 02 REGULAR ( ), 03 PREMIUM ( ) 04 DIESEL ( ) 05 FEASTS OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: .025 ( ) GAUGE (X) INCHES ( ) GM ( ) UNKNOWN <br /> B. ( ) 02 VAULTED (LOCATED INANUNDERGROUND VAULT) (.X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED (X) 02 SINGLE WALLED ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( l 02 STAINLESS-STEEL ( ) 03 FIBERGLASS ( 104 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> t ) 06 ALUMINUM t d 07 STEEL CLAD { l 08 BRONZE ( l 09 COMPOSITE ( ) IO NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />