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• STATE ID NUMBER 00000016430004 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> (�(l 01 NEW PERMIT f 9 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 02 CONDITIONAL PERMIT ( l 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPOP.ATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> PACIFIC BELL ( ) 01 FED ( ) 02 STATE t l 03 LOCAL <br /> STREET ADDRESS CITY / j� STATE ZIP^ �U <br /> -17r-TRTW ST ?bool� /�jM/rN1 CA 7 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> PACIFIC BELL (UE-042)1yK ®� E.J.KOEHLER <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 345 N. SAN JOAQUIN <br /> CITY COUNTY ZIP <br /> STOCKTON M j� SAN JOAQUIN 95202 <br /> i� <br /> MAILING ADOPESS j> T2«T/Hf2 CITY STATE ZIP <br /> CA 94267 AL <br /> PHONE W/AP.EA CODE - p�� - TYPE OF BUSINESS <br /> 415-5* W -L da ( ) 01 GASOLINE STATION (X) 02 OTHER :PHONE CO. <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE S€CTION <br /> .5 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CCD' NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> EMERGENCY CONTROL CENTER 415-5�#'t-�iSffI'�a��777 EMERGENCY CONTROL CENTER 415-"ter$ <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER D-67-25K02 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG C. YEAR INSTALLED 1967 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 25000 GALLONS ( 1 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)= <br /> ( ) 01 UNLEADED ( ) 02 REGULAR t l 03 PREMIUM (X) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( l INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( l 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />