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/aAzp STATE ID NUMBER 00000002364001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) 01 NEW PERMIT ( 1 05 RENEWED PERMIT 1'>40ANK CLOS O ( ) 09 DELETE FROM FILE (NO FEE) <br /> [ l 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 M ANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> JIM THORPE OIL INC. ( 1 01 FED ( ) 02 STATE l 1 03 LOCAL <br /> STREET ADDRESS CITYSTATE ZIP <br /> 351 N BECKMAN RD. LODI CA 95240 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> KEYLOCK LOCATION RICHARD THORPE <br /> STPEET ADOPESS NEAREST CROSS STREET <br /> 421 S CENTRAL AVE FLORA <br /> CITY COUNTY ZIP <br /> LODZ SAN JOAQUIN 95240 <br /> MAILING AJDPESS CITYSTATE ZIP <br /> PO BOX 357 LODI CA 95241 <br /> PHONE W/AREA CODE TYPEOF BUSINESS <br /> 209-368-6175 (X) 01 GASOLINE STATION f ) 02 OTHER <br /> NUMBER OF C NTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <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 /> JIM THORPE 209-368-6175 RICHARD THORPE 209-369-7440 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER <br /> B. MANUFACTURER (IF APPROPRIATE): PERKINS WELDING YEAR MFG: 1966 C. YEAR INSTALLED 1966 ( ) UNKNOWN <br /> 0. CONTAINER CAPACITY: 1000 GALLONS ( ) UNKNOWN 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 /> t%i 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM (A) 04 DIESEL ( ) 05 WASTE OIL [ ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 10 (X) GAUGE f ) INCHES f ) CM f ) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( 1 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED f 1 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS f 1 04 POLYVINYL CHLORIDE f 1 05 CONCRETE <br /> ( ) 06 ALUMINUM f ) 07 STEEL CLAD ( 1 08 BRONZE ( l 09 COMPOSITE ( l 10 NON-METALLIC <br /> f ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />