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STATE' D NUMBER <br /> 000 0019674004 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> l ) 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSEDY0 09 DELETE FROM FILE lN0 FEE] <br /> l ) 02 CONDITIONAL PERMIT f ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (No <br /> S(d(CXARG ) <br /> I OWNER <br /> NAME(CC?FCFAT iON,INO iVZDUAI OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> AGRI BIS INC ( 7 01 FED f ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITU STAT[ ZIP <br /> 1120 W CHARTER WAY STOCKTON CA 95206 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> MID CAL FRACTOR GEORGE W OHM <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1120 W CHARTER WAY ARGONAUT <br /> CITY COUNTY <br /> ZIP <br /> STOCKTON SAN JOAQUIN 95206 <br /> MAILING ADDRESS CITY STATE ZIP <br /> P.O. BOX 6069 STOCKTON CA 95206 <br /> PHONE WIAREA CODE TYPE OF BUSINESS <br /> 209-944-5714 f ) 01 GASOLINE STATION (X) 02 OTHER EQUIP DEALER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 5 <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 /> OHM GEORGE 209-944-5714 OHM GEORGE 209-931-4236 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK f ) 04 OTHER: CONTAINER NUMBER 104 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1971 f ) UNKNOWN <br /> D. CONTAINER CAPACITY: GALLONS (XI UNKNOWN E. DOES THE CONTAINER STORE: (X) 01 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 f ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( 105 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( I INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 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. ( ) 01 CARBON STEEL ( 102 STAINLESS STEEL f 1 03 FIBERGLASS [ 104 POLYVINYL CHLORIDE (X) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD f ) 08 BRONZE ( 1 09 COMPOSITE l ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />