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STATE ID NUMBER 00000040655001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( l 02 CONDITIONAL PERMIT t ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPOP.ATICN,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> HOWARD E RICHARDSON ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITYtiA <br /> TATE T9-520-5 <br /> P <br /> 2662 NORTH WILSON WAY STOCKTON <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> RICK'S NORWALKS SERVICE <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 2662 NORTH WILSON WAY <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95205 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 2662 NORTH WILSON WAY STOCKTON CA 95205 <br /> PHON! W/.AF.EA CODE TYPE OF BUSINESS <br /> 209-465-0133 (X) 01 GASOLINE STATION ( ) 02 OTHER <br /> NUMBER OF CONTAINERS TFUP <br /> AL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 2 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) ANO PHONE W/AREA CODE <br /> RICHARDSON, HOWARD E. 209-465-0133 RICHRDSON, HOWARD E. 209-478-3659 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK t ) 04 OTHER: CONTAINER NUMBER 2 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1962 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY= 2000 GALLONS ( ) UNKNOWN JE. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. 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 ( l 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT= ( ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. (X) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ] 02 SINGLE WALLED t ) 03 LINED <br /> D. ( l 01 CARBON STEEL ( l 02 STAINLESS STEEL ( 103 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( l 05 CONCRETE <br /> ( ) 06 ALUMINUM .t ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( l 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />