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.. '� <br /> STATE ID ))UMBER 00000015190001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED <br /> ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( 1 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> PUBLIC AGENCY ONLY <br /> NAME(CORPORATZON,INOIVIDUAL OR PUBLIC AGENCY) ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> BERT SALLATORE <br /> CITY STATE 2IP <br /> STREET ADDRESS _�,,j., RIPON CA 95366 <br /> 19888 t <br /> II FACILITY <br /> DEALER/FOREM.AN/SUPERVISOR <br /> FACILITY NAME BERT BALLATORE <br /> BERT BALLATORE <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 19875 S CARROLTON HIWAY 120 <br /> CITY COUNTY ZIP <br /> RIPON SAN JOAQUIN 95366 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 19988 S CARRALTON RIPON CA 95366 <br /> pPHO8,EqW/AR!A CODE TYPE OF BUSINESS3476 ( ) O1 GASOLINE STATION (X) 02 OTHER FARM <br /> F CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> 2S BE 3 <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 /> BALLATORE BERT 209-599-3476 BALLATORE, BERT 209-599-3476 <br /> ,;OMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: GALLONS (X) UNKNOWN E. DOES THE CONTAINER STORE: ( ) O1 WASTE ( 1 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? f ) 01 YES (X) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM f 1 04 DIESEL f 1 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( 1 GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. f ) Ol VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. < ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( 1 02 STAINLESS STEEL f ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> t ) 06 ALUMINUM f 1 07 STEEL CLAD ( 1 08 BRONZE ( 1 09 COMPOSITE l 1 10 NON-METALLIC <br /> f 112 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />