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i <br /> • STATE ID NUMBER 00000016430002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 0 <br /> 1 NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( l 09 DELETE FROM FILE (NO FEE) <br /> 1 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COR=CRATION,IND:VIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> PACIFIC BELL ( ) 01 FED ( l 02 STATE ( 1 03 LOCAL <br /> STREET ADDRESSCITY STATE ZIP <br /> sgper�( rxo oz�SD — —�� �� o cAgy <br /> II FACILITY <br /> FACILITY NAME OEALEP./FOREMAN/SUPERVISOR <br /> PACIFIC BELL (UE-042) �jKT/ /¢Q E.J.KOEHLER <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 345 N. SAN JOAQUIN <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95202 <br /> MAILING ADDRESS Pf'7TrM-T_rh6Z CITY L� � STATE ZIP <br /> ej� �f(co /70_ W^1F/ CA JNrYOZ` <br /> PHONE W/.ARE.A CODE TYPE OF BUSINESS <br /> 01 GASOLINE STATION (X) 02 OTHER PHONE CO. <br /> NUMBER OF CONTAINERS RURAL 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 /> EMERGENCY CONTROL CENTER 415-�54£-4694-?a _ ? EMERGENCY CONTROL CENTER 415-542-46"s 8a`?,-'T?? <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER D-55-300 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG C. YEAR INSTALLED 1955 ( l UNKNOWN <br /> D. CONTAINER CAPACITY: 300 GALLONS ( ) 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 ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( l 02 REGULAR t ) 03 PREMIUM (X) 04 DIESEL f ) 05 WASTE OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( 1 GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (t) 02 SINGLE WALLED t ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL t ) 03 FIBERGLASS t ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( 1 09 COMPOSITE ( l 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />