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STATE ID NUMBER 00000012631001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> t ) 01 NEW PERMIT ( D 05 RENEWED PERMIT ( ) 07 TANK CLOSED' t D 09 DELETE FROM FILE (NO FEE) <br /> J 02 CONDITIONAL PERMIT f ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (.NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPOP.ATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> SHELL OIL COMPANY ( D O1 FED t ) 02 STATE t ) 03 LOCAL <br /> —] <br /> STREET ADDRESS CITY STATE ZIP <br /> P.O. BOX 4848 ANAHEIM CA 92803 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR `-- <br /> SHELL FOOD MART O b <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 2320 ELDORADO <br /> CITY COUNTY ZIP <br /> STOCKTON ISAN JOAQUIN 95204 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 2320 ELDORADO STOCKTON CA 95204 <br /> PHONE W/AP.EA CODE TYPE OF BUSINESS <br /> 209-943-1311 (X) 01 .GASOLINE STATION ( ) 02 OTHER <br /> NUMBER OF CONTAINERS RUP.AL AREAS ONLY TOWNSHIP RANGE SECTION , <br /> 4 <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 /> 101111+-ft fG4(- BOB LUTZ 209-957 <br /> COMPUTE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: C. YEAR INSTALLED 1968 ( ) UNKNOWN <br /> 0. CONTAINER CAPACITY 550 GALLONS ( I UNKNOWN JE. DOES THE CONTAINER STORE: (X) 01 WASTE ( D 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES f ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> { D 01 UNLEADED' f ) 02 REGULAR ( ) 03 PREMIUM t ) 04 DIESEL (X) 05 WASTE OIL t l 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARYCONTAINMENT 12 (X) GAUGE { D INCHES ( ) CM t ) UNKNOWN <br /> S. ( ) .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. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL t ) 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE t ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD f ) 08 BRONZE ( ) 09 COMPOSITE t D 10 NON.-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (1.0/18185) PAGE I <br />