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P, 'Js <br /> WAeVW t" STATE ID NUMBER 00000052900002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND ST AGE TANK <br /> ( ) <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED 09 DELETE FROM FILE (NO FEE) <br /> 1 1 02 CONDITIONAL PERMIT f l 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHA <br /> I OWNER <br /> NAME(CORPORATION.INDIVIDUAL OR PUBLIC AOENCY) PUBLIC AGENCY ONLY <br /> TOWER PARK MARINA ( ) 01 FED [ ) 02 STATE [ l 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 14900 WEST HWY 12 LODI CA 95240 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> TOWER PARK MARINA <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 14900 WEST HWY 12 I-5 FREEWAY <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 14900 WEST HWY 12 LODI CA 95240 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-369-1041 ( ) 01 GASOLINE STATION (X) 02 OTHER MARINA <br /> NUMBER OF CONTAINERS RURAL 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) AND PHONE W/AREA CODE <br /> STEVE WOODARD 209-369-1041 - <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 2 <br /> B. MANUFACTURER (If APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1972 ( 1 UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS ( ) UNKNOWN I E. DOES THE CONTAINER STORE: f ) 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 ( ) 04 DIESEL ( ) 05 WASTE OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: [ ) GAUGE l ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( ) 03 LINED <br /> 0. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE t ) 09 COMPOSITE f ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />