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TATE ID NUMBER <br /> �. • TORAGE IANKiy_-_l <br /> PERMIT TO OPERATE UNDERGROUND 1 1 09 DELETE FRDM FILE lN0"FEE T I <br /> APPLICATION FOR — <br /> _ _---- -- <br /> �-_ 1 1 06 MINOR CHANGECHARGE) <br /> ( 1 05 RENEWED PER 06 <br /> 1 1 07 TANK CLOSE _ <br /> ( O1 NEW PERMIT ( 1 06 AMENOEOPERMIT -_ <br /> 1 02 Cpl10ITIONAL PERMIT _ - -_-- <br /> I __..---- --- PUBLIC AGENCY ONLY E j 'OS LOCAL <br /> _ ( 1 O1 FED 1 1 02 STATE <br /> DWNER <br /> INDIVIDUAL OR CVOLIC AGENCY ' T �r — ZIP <br /> NAP.EICCPPORATIDN. � STATE <br /> qS �2� <br /> C C I x <br /> C�T1Lu C.� <br /> STREET AclRES <br /> II FACILITY --- DEALEP/rOPEMf",SUPERVISOo <br /> r14^CILITr NAME - <br /> 1: LCG -To_ 7F�� <br /> NEAREST CROff STREET <br /> 'fnelr Ac0=es5 ZIP <br /> q <br /> 6 COUNTY <br /> 1 CL 11Y <br /> ITY ,,� STATE ZIPit 34-D -- <br /> u ' _ CITY , -' ` - C*q- AS- <br /> ) GADDPESS <br /> ATL�.0 <br /> TYPE CP BUSINESS LINE ,�[. 02 OTHER <br /> r11oN u%AP CODE � ( 1 O1 GASOLINE STATION Y.r _ <br /> 1 ��M ��0M PANGS SECTION <br /> RURAL APEAS ONLY : TOWNSHIP <br /> WUCOFR Of CONTAINERS _----- —— _ -- <br /> LII 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAr,FIlAST NAME FIP5T1 AND PNO E W/AVER CODE NIGHTS: NAMEI LAST NAME FIRST) AND <br /> PHONE W/AREA..000E <br /> a b X333 e���rs°Y` �K '(,;09 q7t <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION — <br /> __—.___.--_--_—_----- —_- CONTAINER NUMBER <br /> A. 1I O1 TANK l 1 02 OTHER: ,^ <br /> e. MANUFACTURER LIF APPROPRIATE): — YEAR MFG: C. YEAR INSTALLED ( 1 UNKNOWN <br /> 0. CONTAINER CAPACITY: p GALLONS 1 1 UNKNOWN E. DOES THE CONTAINER STORE: 1 1 01 WASTE /1 02 PRODUCT <br /> F DOES THE CONTA114ER STORE MOTOR VEHICLE FUEL DR WASTE OIL ? 1/V 01 YES 1 1 02 NO IF YES CHECK APPROPRIATE BOK(ESI: <br /> ( I 01 UNLEADED l 1 02 REGULAR l 1 03 PREMIUM l 1 04 DIESEL_ l 1 05 HASTE OIL 1 ) 06 OTHER _— <br /> V CONTAINER CONSTRUCTION <br /> ICY.NE.SS OF PRIMARY CONTAINMENT: ( 1 GAUGE 1 1 INCHES 1 1 CM—( I UNKNOWN <br /> B. l 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (XI 02 NON-VAULTED 1 1 03 UNKNOWN — <br /> IC. ( 1 O1 DOUBLE WILLED (YA 02 SINGLE WALLED 1 1 03 LINED <br /> D. 1�lfj 01 CARBON STEEL I 1 02 STAINLESS STEEL 1 1 03 FIBERGLASS l 1 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> 1 1 06 ALUMINUM 1 1 07 STEEL CLAD 1 1 DO BRONZE 1 1 09 COMPOSITE 1 1 10 NON-METALLIC <br /> 1 '1 12 V11KNOWII 1 1 13 OTHER: <br /> -- -- - - PAGE <br /> II5C04-070185 <br /> v.• <br />