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STATE ID NUMBER 00000002150003 <br />APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br />'q} 01 NEW PERMIT ( } 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( l 09 DELETE FROM FILE (NO FEE) <br />( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br />!I OWNER <br />NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) <br />(X) 01 TANK ( ) 04 OTHER <br />PUBLIC AGENCY ONLY <br />CANEPA'S`CAR WASH <br />CANEPA'S CAR WASH <br />t ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br />STREET ADDRESSCITY <br />0 <br />STATE <br />ZIP <br />!1536 N HUNTER <br />STOCKTON <br />CA <br />95204 <br />II FACILITY <br />FACILITY NAME <br />(X) 01 TANK ( ) 04 OTHER <br />DEALER/FOREMAN/SUPERVISOR <br />CONTAINER NUMBER C <br />CANEPA'S CAR WASH <br />MANUFACTURER (IF APPROPRIATE): <br />REau- um" Eke <br />0 <br />STREET ADDRESS <br />CONTAINER CAPACITY: 5000 GALLONS ( 1 UNKNOWN <br />NEAREST CROSS STREET <br />F. <br />642 N HUNTER <br />D. <br />(X) 01 <br />( ) <br />( l 12 <br />CARBON STEEL ( ) 02 STAINLESS STEEL ( <br />06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 <br />UNKNOWN ( ) 13 OTHER: <br />CITY <br />POLYVINYL CHLORIDE ( l 05 CONCRETE <br />( ) 10 NON-METALLIC <br />COUNTY <br />ZIP <br />`STOCKTON <br />SAN JOAQUIN <br />95204 <br />MAILING ADDRESS <br />CITY <br />STATE <br />ZIP <br />642 N HUNTER <br />STOCKTON <br />CA <br />95204 <br />PHONE W/AREA CODE <br />TYPE OF BUSINESS <br />209-948-1636 <br />r <br />(�) 01 GASOLINE STATION � 02 OTHER C <br />f,<,/ -� C <br />NUMBER OF CONTAINERS <br />RURAL AREAS ONLY <br />TOWNSHIP <br />RANGE <br />ECTION <br />3 <br />III 24 HOUR EMERGENCY CONTACT PERSON <br />)AYS: NAME(LAST NAME FIRST) AND PHONE W/ARE.A CODE NIGHTS: N.AME(L.AST NAME FIRST) AND PHONE W/AREA CODE <br />tEMO 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 C <br />B. <br />MANUFACTURER (IF APPROPRIATE): <br />YEAR MFG: <br />C. YEAR INSTALLED (X) UNKNOWN <br />D. <br />CONTAINER CAPACITY: 5000 GALLONS ( 1 UNKNOWN <br />JE. DOES THE CONTAINER STORE: t ) 01 WASTE (X) 02 PRODUCT <br />F. <br />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 ( ) 03 PREMIUM (X) 04 DIESEL ( ) 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 />t ) 01 <br />VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON -VAULTED ( <br />) 03 UNKNOWN <br />C. <br />( l 01 <br />DOUBLE WALLED (X) 02 SINGLE WALLED ( <br />) 03 LINED <br />D. <br />(X) 01 <br />( ) <br />( l 12 <br />CARBON STEEL ( ) 02 STAINLESS STEEL ( <br />06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 <br />UNKNOWN ( ) 13 OTHER: <br />} 03 FIBERGLASS ( ) 04 <br />BRONZE t ) 09 COMPOSITE <br />POLYVINYL CHLORIDE ( l 05 CONCRETE <br />( ) 10 NON-METALLIC <br />HSC04-070185 (10/18/85) <br />` r � <br />PAGE 1 <br />