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STATE ID NUMBER 00000051098002 <br />APPLICATION FOR :PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br />(,W 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br />t ) 02 CONDITIONAL PERMIT t ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br />I OWNER <br />NAME(CORPOPATION,INDIVZDUAI <br />OR PUBLIC AGENCY) <br />DEALER/F REMAN/SUPERVISOR <br />PUBLIC AGENCY ONLY <br />R- CES y i <br />j . e <br />STREET ADDRESS <br />( ) 01 FED t ) 02 STATE } 03 LOCAL <br />STREET ADDRESSSTATE <br />Mor k_ -C.(5c® <br />TYe <br />[C' <br />1 CA <br />ZIP � {® <br />II FACILITY <br />FACILITY NAME <br />(X) 01 TANK ( ) 04 OTHER: <br />DEALER/F REMAN/SUPERVISOR <br />RICK'S CHEVRON SERVICE <br />B. <br />"A&f-R- v—iC,k_ l e- <br />STREET ADDRESS <br />C. YEAR INSTALLED 1983_ ( I UNKNOWN <br />NEAREST CROSS STREET <br />8660 LOWER SACTO RD. <br />E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br />PONCE DE LEON <br />CITY <br />) 02 SINGLE WALLED <br />COUNTY <br />ZIP <br />STOCKTON <br />( ) 01 <br />t ) <br />(X) 12 <br />SAN J'OAQUIN <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 />(XI 01 GASOLINE STATION ( ) 02 OTHER <br />NUMBER OF CONTAINERS <br />RURAL AREAS ONLY <br />TOWNSHIP <br />FANGE <br />SECTION <br />3 <br />III 24 HOUR EMERGENCY CONTACT PERSON <br />DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE �GONZALES, <br />IGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREAA CODE <br />GONZALES, RICK 209-477-0947 RICK 209-952-2629 <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. <br />(X) 01 TANK ( ) 04 OTHER: <br />t ) GAUGE ( } INCHES ( <br />CONTAINER NUMBER 2 <br />B. <br />14ANUFACTURER (IF APPROPRIATE): <br />YEAR MFG: <br />C. YEAR INSTALLED 1983_ ( I UNKNOWN <br />0. <br />CONTAINER CAPACITY: 10000 GALLONS ( ) UNKNOWN <br />E. DOES THE CONTAINER STORE: ( ) 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 (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL t ) 06 OTHER <br />V CONTAINER CONSTRUCTION <br />A. <br />THICKNESS OF PRIMARY CONTAINMENT: <br />t ) GAUGE ( } INCHES ( <br />) CM (X) UNKNOWN <br />B. <br />( ) 01 <br />VAULTED (LOCATED <br />IN AN UNDERGROUND <br />VAULT) (X) 02 NON -VAULTED ( <br />) 03 UNKNOWN <br />C. <br />( ) 01 <br />DOUBLE WALLED ( <br />) 02 SINGLE WALLED <br />( ) 03 LINED <br />0. <br />( ) 01 <br />t ) <br />(X) 12 <br />CARBON STEEL ( <br />06 ALUMINUM ( ) <br />UNKNOWN (. ) 13 <br />) 02 STAINLESS STEEL (X) 03 FIBERGLASS t ) 04 <br />07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE <br />OTHER`: <br />POLYVINYL CHLORIDE t ) 05 CONCRETE <br />( ) 10 NON-METALLIC <br />HSC04-070185 (10/18/85) <br />PAGE 1 <br />