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STATE ID NUMBER 00000065863001 <br />APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br />VL) 07 TANK CLOSED 09 DELETE FROM FILE (NO FEET <br />( ) 08 MINOR CHANGE (NO SURCHARGE) <br />( ) O1 NEW PERMIT <br />( ) 02 CONDITIONAL PERMIT <br />( 1 05 RENEWED PERMIT <br />( ) 06 AMENDED PERMIT <br />I OWNER <br />NAME(CORP ORATION�INOIVIDVAL OR PUBLIC AGENCY) <br />LODI UNIFIED SCHOOL DISTRICT <br />STREET ADDRESS <br />815 WEST LOCKEFORO STREET <br />II FACILITY <br />FACILITY NAME <br />WOODBRIDGE MIDDLE SCHOOL <br />STREET ADDRESS <br />18500 LILAC STREET <br />CITY <br />WOODBRIDGE <br />MAILING ADDRESS <br />18500 LILAC STREET -- <br />PHONE W/AREA CODE <br />209-369-7411 <br />NUMBER OF CONTAINERS <br />1 <br />PUBLIC AGENCY ONLY <br />( ) 01 FED ( ) 02 STATE 1 1 03 LOCAL <br />CITY STATE ZIP <br />LODI CA 95240 <br />DEALER/FOREMAN/SUPERVISOR <br />RALPH BLUMENTHAL <br />NEAREST CROSS STREET <br />ZIP <br />COUNTY 95258 <br />SAN JOAQUIN <br />STATE ZIP <br />(BRIDGE CA 95258 <br />FTYPE OF BUSINESS <br />( 1 01 GASOLINE STATION (X) 02 OTHER MIDDLE SCHOOL <br />RANGE <br />N SECTION <br />RURAL AREAS ONLY TOWNSHIP 6 E POR <br />4 <br />III 24 HOUR EMERGENCY CONTACT PERSON <br />DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br />FISCHER, LEONARD 209-369-1242 <br />NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br />FISCHER, LEONARD 209-333-1565 <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. (X) 01 TANK ( ) 04 OTHER: <br />MANUFACTURER (IF APPROPRIATE): <br />CONTAINER NUMBER W.S. 001 <br />YEAR MFG: I C. YEAR INSTALLED (X) UNKNOWN <br />D CONTAINER CAPACITY GALLONS (X) UNKNOWN IE. DOES THE CONTAINER STORE: ( ) O1 WASTE (X) 02 PRODUCT <br />F. DO'O04 <br />DOES THE CONTAINER STOREMOTORVEHICLE FUEL ORMWA(T) OIL <br />DI E( ) 0( )E05 (X)02WASTE0IOO (I1 YESOCHECK APPROPRIATE BOX(ES): <br />V r.nNTAINER CONSTRUCTION <br />A. THT[KNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( 1 CM (X) UNKNOWN <br />B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON -VAULTED (X) 03 UNKNOWN <br />I I m nMIRLE WALLED ( ) 02 SINGLE WALLED ( ) 03 LINED <br />D. ( )Ip; 06RALUMITNUM (1 )) 072 STAINLESS <br />STEEL 08( BRONZEFIBERG 095 COMPOSITE POLYVINYL110NON-METALLIC( ) 05 CONI.HGIt <br />rv) TP LPMNOWN ( ) 13 OTHER: <br />HSC04-070185 (08/29/86) <br />PAJ <br />