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STATE ID NUMBER 00000051098001 <br />APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br />Ol NEW PERMIT f B 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br />( ) 02 CONDITIONAL PERMIT t ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br />I OWNER <br />NAME(CORPORATION,INDIVIDUA;L OR PUBLIC AGENCY) <br />II <br />CONTAINMENT: ( ) GAUGE ( ) INCHES ( <br />AGENCY ONLYvr`®B� <br />RICK'S CHEVRON SERVICE <br />G(. <br />Daae- i As—_a_( e-5 <br />FIC <br />01 FED t } 02 STATE t ) 03 LOCAL <br />STREET ADDRESS� <br />�" 7 T S <br />NEAREST CROSS STREET <br />CITY <br />Ki,C.C.SC o <br />STATE <br />CA <br />ZIP 4e®(® <br />, n <br />46444 - <br />II FACILITY <br />FACILITY NAME <br />CONTAINMENT: ( ) GAUGE ( ) INCHES ( <br />DEALER/FOREMAN/SUPERVISOR <br />RICK'S CHEVRON SERVICE <br />01 <br />Daae- i As—_a_( e-5 <br />STREET ADDRESS <br />C. ( ) <br />NEAREST CROSS STREET <br />8660 LOWER SACTO RD. <br />) 02 SINGLE WALLED -t )'03 LINED <br />PONCE DE LEON <br />CITY <br />01 <br />t ) <br />12 <br />COUNTY <br />ZIP <br />STOCKTOt( <br />SAN JOAQUIN <br />95210 <br />MAILING ADDRESS <br />CITY <br />STATE <br />ZIP <br />8660 LOWER SACTO RD. <br />STOCKTON <br />CA <br />95210 <br />PHONE W/APER CODE <br />TYPE OF BUSINESS <br />209-477-0947 <br />(X) 01 GASOLINE STATION t ) 02 OTHER <br />NUMBER OF CONTAINERSRURAL <br />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/ARE.A CODE <br />GONZALES, RICK 209-477-0947 GONZALES, RICK 209-952-2629 <br />COMPLETEJHE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. (X) 01 TANK" ( ) 04 OTHER: CONTAINER NUMBER 1 <br />B. <br />MANUFACTURER (IF APPROPRIATE): YEAR MFG: 71C. YEAR INSTALLED 1983 f ) UNKNOWN <br />D. CONTAINER CAPACITY: 10000 GALLONS 't ) UNKNOWN JE. DOES THE CONTAINER STORE: ( } 01 WASTE (X) 02 PRODUCT <br />F. ObES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES t } 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br />01 UNLEADED ( } 02 REGULAR tj6 03 it PREMIUM f D 04 DIESEL d } 05 WASTE OIL t } 06 OTHER <br />r <br />V CONTAINER CONSTRUCTION � <br />A. THICKNESS OF PRIMARY <br />CONTAINMENT: ( ) 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,( <br />) 02 SINGLE WALLED -t )'03 LINED <br />D.,f ) <br />(X) <br />01 <br />t ) <br />12 <br />CARBON STEEL <br />06 ALUMINUM <br />UNKNOWN ( ) <br />t ) 02 STAINLESS STEEL -(X) 03 FIBERGLASS ( l 04 <br />( ) 07 STEEL CLAD ( l 08 BRONZE C } 09 COMPOSITE <br />13 OTHER: <br />POLYVINYL CHLORIDE ( ) 05 CONCRETE <br />( ) 10 NON-METALLIC <br />HSC04-070185 (10/18/85) <br />;a <br />PAGE 1 <br />