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0 • STATE ID NUMBER 00000006102001 <br />APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br />( 1 <br />01 NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED9 DELETE FROM FILE (NO FEE) <br />( ) 02 CONDITIONAL PERMIT f 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCH ) <br />I OWNER <br />NAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br />NEW HIGHWAY CARRIER ( ) 01 FED ( ) 02 STATE ( l 03 LOCAL <br />STREET ADDRESS CITY STATE ZIP <br />651 STOCKTON ST RIPON CA 95366 <br />II FACILITY <br />FACILITY NAME <br />(X) 01 TANK ( ) 04 OTHER <br />DEALER/FOREMAN/SUPERVISOR <br />CONTAINER <br />TRUCK YARD <br />B. <br />LARRY -GREEN SR <br />YEAR MFG= <br />STREET ADC?ESS <br />YEAR INSTALLED 1983 ( 1 UNKNOWN <br />NEAREST CROSS STREET <br />CONTAINER CAPACITY: 10000 GALLONS f <br />651 STOCKTON ST <br />E. DOES THE CONTAINER STORE: [ <br />5TH ST <br />F. <br />CITY <br />FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO <br />PREMIUM (X) 04 DIESEL ( ) 05 WASTE OIL <br />COUNTY <br />ZIP <br />RIPON <br />01 <br />) <br />12 <br />SAN JOAQUIN <br />l 02 STAINLESS STEEL <br />07 STEEL CLAD f ) 08 <br />OTHER: <br />95366 <br />MAILING ADDRESS <br />CITY <br />STATE <br />ZIP <br />P.O. BOX 751 <br />RIPON <br />CA <br />95366 <br />PHONE W/AREA CODE <br />TYPE OF BUSINESS <br />209-599-6166 <br />( ) 01 GASOLINE STATION (X) 02 OTHER TRUCKING <br />NUMBER. OF CONTAINERS <br />RURAL AREAS ONLY <br />TOWNSHIP <br />RANGE <br />SECTION <br />1 <br />III 24 HOUR EMERGENCY CONTACT PERSON <br />DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(IAST NAME FIRST) AND PHONE W/AREA CODE <br />LAWRENCE GREEN SR 209-599-6166 <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. <br />(X) 01 TANK ( ) 04 OTHER <br />fX) GAUGE <br />CONTAINER <br />NUMBER 1 <br />B. <br />MANUFACTURER (IF APPROPRIATE): 1970 <br />YEAR MFG= <br />C. <br />YEAR INSTALLED 1983 ( 1 UNKNOWN <br />D. <br />CONTAINER CAPACITY: 10000 GALLONS f <br />1 UNKNOWN <br />E. DOES THE CONTAINER STORE: [ <br />) 01 WASTE (X) 02 PRODUCT <br />F. <br />DOES THE CONTAINER STORE MOTOR VEHICLE <br />( ) 01 UNLEADED ( ) 02 REGULAR f ) 03 <br />FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO <br />PREMIUM (X) 04 DIESEL ( ) 05 WASTE OIL <br />IF YES CHECK APPROPRIATE BOX(ES): <br />[ ) 06 OTHER <br />V CONTAINER CONSTRUCTION <br />A. <br />THICKNESS OF PRIMARY CONTAINMENT: <br />fX) GAUGE <br />( ) INCHES ( <br />) CM ( ) UNKNOWN <br />B. <br />( ) <br />01 <br />VAULTED (LOCATED <br />IN AN UNDERGROUND VAULT) (X) 02 <br />NON -VAULTED ( <br />) 03 UNKNOWN <br />C. <br />(X) <br />01 <br />DOUBLE WALLED ( <br />1 02 SINGLE WALLED ( <br />l 03 LINED <br />D. <br />fX) <br />( <br />f ) <br />01 <br />) <br />12 <br />CARBON STEEL f <br />06 ALUMINUM ( 1 <br />UNKNOWN ( ) 13 <br />l 02 STAINLESS STEEL <br />07 STEEL CLAD f ) 08 <br />OTHER: <br />f ) 03 FIBERGLASS l ) 04 <br />BRONZE ( l 09 COMPOSITE <br />POLYVINYL CHLORIDE ( ) 05 CONCRETE <br />( 1 10 NON-METALLIC <br />HSC04-070185 (10/18/85) <br />PAGE I <br />