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STATE ID NUMBER 00000064319003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TA, CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> N.AME(COPPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> QUENTIN 0. KIRSCH I J ) 01 FED t ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 190 E AMBER WAY HANFORD CA 93230 <br /> II FACILITY <br /> FACILITY NAME DE LER/FOREMAN/SUPERVISOR <br /> BEACON 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 952.03 <br /> MAILING ADDRESS =HAINY STATE ZIP <br /> 525 WEST THIRD STREET FORD CA 93230 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-582=0241 (X) 01 GASOLINE STATION ( D 02 OTHER <br /> NUMBER 4FKim�/CONTAINEP,S RUP,AI AREAS ONLY TOWNSHIP RANGE SECTION <br /> 1-yN <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LA.ST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> MCCUTCH€N, JIM 209-582-0241 SHIFT SUPERVISOR 209-5,82-0246 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAIN-ER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER #6t0--3- <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: ( ) 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)z <br /> (X) 01 UNLEADED ( ) 02 REGULAR ( ) 03, PREMIUM ( ) 04 DIESEL ( D 05 WASTE OIL t D 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: .025 ( ) GAUGE (X) INCHES ( ) CM t D UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C ( ) 01 DOUBLE WALLED M 02 SINGLE WALLED ( D 03 LINED <br /> D. (X) 01 CARBON STEEL t- ) 02 STAINLESS STEEL t ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE t ) 45 CONCRETE <br /> E ) 06 ALUMINUM ( ) 07 STEEL CLAD t ) 08 BRONZE E ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> i2 UNKNOWN t l 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />