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NOT OW AMIW9�s <br /> STATE ID NUMBER 00000019674003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ! ) 01 NEW PERMIT f ] 05 RENEWED PERMIT ( ) 07 TANK CLOSED (x) 09 DELETE FROM FILE (NO FEE) <br /> l 7 02 .CONDITIONAL PERMIT ( J 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) - <br /> I OWNER <br /> NAME(CORPOPATIONIINOIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> AGRI BIS INC ( ) 01 FED f ) 02 STATE ! ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 1120 W CHARTER WAY STOCKTON CA 95206 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> MIO CAL FRACTOR GEORGE W OHM <br /> STREET FCC-ESS NEAREST CROSS STREET <br /> 1120 W CHARTER WAY ARGONAUT <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95206 <br /> MAILIN3 ADOPESS CITY STATE ZIP <br /> P.O. BOX 6069 STOCKTON CA 95206 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-944-5714 ( ) 01 GASOLINE STATION (X) 02 OTHER EQUIP DEALER <br /> NUMBER OF CONTAINERS PUPAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 5 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST] AND PHONE W/AREA COOK NIGHTS: NAME(IAST 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 ( l 04 OTHER: CONTAINER NUMBER 103 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1971 ( 1 UNKNOWN <br /> D. CONTAINER CAPACITY: GALLONS (X) UNKNOWN E. DOES THE CONTAINER STORE: (X) 01 WASTE [ ) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES (X) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( 7 03 PREMIUM ( ) 04 DIESEL f 1 05 WASTE OIL f 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: [ ) GAUGE ( 1 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 l ) 03 LINED <br /> 0. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 103 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE (X) 05 CONCRETE <br /> ( ) 06 ALUMINUM f l 07 STEEL CLAD f ) 08 BRONZE ( ] 09 COMPOSITE ( 1 10 NON-METALLIC <br /> t ) 12 UNKNOWN ( 1 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />