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• STATE 10 NUMBER 00000035403001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND TORAGE TANK <br /> E ) 01 NEW PERMIT ( l 05 RENEWED PERMIT ( ) 07 TANK CLOSED ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( l 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHAR <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGE Y LY <br /> CALIFORNIA HIGHWAY PATROL ( ) 01 FED ) 02 STATE t 1 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> P.O. BOX 898 SACRAMENTO CA 95804 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> CALIFORNIA HIGHWAY PATROL <br /> rtTREET AODRESS NEAREST CROSS STREET <br /> 4330 N. AD ART RD. <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95208 <br /> MAILING ADDRESS CITY STATE ZIP <br /> P.O. BOX 8466 STOCKTON CA 95208 <br /> PHONE W/AREA CODE TYPE OF BUSINISS <br /> 916-322-5310 ( I 01 GASOLNE STATION (X) 02 OTHER CHP <br /> NUMBER OF CONTAINERS RRANGE SECTION <br /> URAL AREAS ONLY TOWNSHIP <br /> 1 <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 /> FACILITIES SECTION 916-322-S310 .I DISPATCHER 916-445-2211 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. ( ) 01 TANK (X) 04 OTHER: SUMP CONTAINER NUMBER 265-2 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: GALLONS (XI UNKNOWN JE. DOES THE CONTAINER STORE: (X) 01 WASTE t ) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES (X) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( 106 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: t ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. t ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE (X) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( l 08 BRONZE ( ) 09 COMPOSITE t ) 10 NON-METALLIC <br /> t ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />