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STATE ID NUMBER 00000002150001 <br />APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br />Ntl 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br />?"1 02 CONDITIONAL PERMIT ( l 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br />I OWNER <br />NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) <br />PUBLIC AGENCY ONLY <br />CANEPA'S CAR WASH <br />i l 01 FED ( l 02 STATE ( ) 03 LOCAL <br />STREET ADDRESS <br />CITY <br />STATE <br />ICA <br />ZIP <br />1536 N HUNTER <br />STOCKTON <br />STREET .ADDRESS <br />95204 <br />II FACILITY <br />FACILITY NAME <br />(X) 01 TANK ( ) 04 OTHER: <br />DEALER/FOREMAN/SUPERVISOR <br />CONTAINER NUMBER A <br />B. <br />CANEPA'S CAR WASH <br />YEAR MFG: <br />VANGG-CA 4PPA __A,: ,, i <br />4 <br />CONTAINER CAPACITY: 12000 GALLONS ( l UNKNOWN <br />STREET .ADDRESS <br />CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br />NEAREST CROSS STREET <br />DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) <br />(X) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL <br />01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br />( ) 05 WASTE OIL ( ) 06 OTHER <br />642 N HUNTER <br />9 03 FIBERGLASS ( l 04 <br />BRONZE ( ) 09 COMPOSITE <br />POLYVINYL CHLORIDE ( ) 05 CONCRETE <br />( ) 10 NON-METALLIC <br />CITY <br />COUNTY <br />ZIP <br />STOCKTON <br />SAN JOAQUIN <br />95204 <br />MAILING ADDRESS <br />CITY <br />STATE <br />ZIP a, <br />642 N HUNTER <br />STOCKTON <br />CA <br />95204 <br />PHONE W/AREA CODE <br />TYPE OF BUSINESS <br />209-948-1636 <br />( ) O1 GASOLINE STATION (-`) 02 OTHER <br />NUMBER OF CONTAINERS <br />RURAL AREAS ONLY <br />TOWNSHIP <br />RANGE <br />SECTION <br />3 <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 />REMO CANEPA 209-465-6114 SAME - - <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. <br />(X) 01 TANK ( ) 04 OTHER: <br />( ) GAUGE ( ) INCHES ( <br />CONTAINER NUMBER A <br />B. <br />MANUFACTURER (IF APPROPRIATE): <br />YEAR MFG: <br />C. YEAR INSTALLED (X) UNKNOWN <br />D. <br />CONTAINER CAPACITY: 12000 GALLONS ( l UNKNOWN <br />JE. DOES THE <br />CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br />F. <br />DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) <br />(X) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL <br />01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br />( ) 05 WASTE OIL ( ) 06 OTHER <br />V CONTAINER CONSTRUCTION <br />A. <br />THICKNESS OF PRIMARY CONTAINMENT: <br />( ) GAUGE ( ) INCHES ( <br />) CM (X) UNKNOWN <br />B. <br />( ) 01 <br />VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON -VAULTED ( <br />) 03 UNKNOWN <br />C. <br />( ) 01 <br />DOUBLE WALLED (X) 02 SINGLE WALLED ( <br />) 03 LINED <br />D. <br />(X) 01 <br />( ) <br />l 12 <br />CARBON STEEL ( l 02 STAINLESS STEEL ( <br />06 ALUMINUM ( ) 07 STEEL CLAD ( l 08 <br />UNKNOWN ( ) 13 OTHER: <br />9 03 FIBERGLASS ( l 04 <br />BRONZE ( ) 09 COMPOSITE <br />POLYVINYL CHLORIDE ( ) 05 CONCRETE <br />( ) 10 NON-METALLIC <br />HSC04-070185 (10/18/85) <br />• <br />PAGE 1 <br />