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�.. <br /> STATE IO NUMBER 00000057549001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> J 01 NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> t ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPORATyI�ON�. NDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> GEWEKE FORD ( ) 01 FED ( 1 02 STATE f ) 03 LOCAL <br /> STREET ADDRESS CITYSTATE ZIP <br /> 1045 S. CHEROKEE LORI CA 95240 <br /> II FACILITY <br /> FACILITY NAME DE)R/FOREMAN/SUPER SOR <br /> GEWEKE FORD <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1045 S. CHEROKEE <br /> CITY COUNTYIIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESS ,, CITY STATE Zip <br /> 144;-8;-&+EROKipF : c 600 � LODI CA 95240 <br /> PHONE W/ARCA CODE GG TYPE OF BUSINESS <br /> 01 GASOLINE STATION (X) 02 OTHER (� <br /> NUMBER OF CONTAINERS RVRAL AREAS ONLY TOWNSHIP RANGE SCCTION <br /> Ya <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME[LAST NAME FIRST) AND PHONE W/AREA CODENIGHTS: N.AME(LAST NAME F RST) AND PHONC W/AREA CODE <br /> uek 5m <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK I ) 04 OTHER: CONTAINER NUMBER/a <br /> B. MANUFACTURER (IF APPROPRIATE!: STOCKTON SERV EQUIPT. YEAR MFG: C. YEAR INSTALLED (Qf%F)H UNKNOWN <br /> I). CONTAINER CAPACITY: 5-CO-GALLONS 0H UNKNOWN E. DOES THE CONTAINER STORE: (X) 01 WASTE ( 1 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (XI 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( 1 01 UNLEADED ( ) 02 REGULAR ( 1 03 PREMIUM ( ) 04 DIESEL (X) 05 HASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f ) GAUGE ( 1 INCHES [ ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED SIN AN UNDERGROUND VAULT) ( 02 NON-VAULTED WR 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED .1X) 02 SINGLE WALLED ( 1 03 LINED <br /> 0. ( ) 01 CARBON STEEL ( 1 02 STAINLESS STEEL ( ) 03 FIBERGLASS 1 1 04 POLYVINYL CHLORIDE I l 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD l 1 08 BRONZE f ) 09 COMPOSITE ( ] 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: - <br /> HSC04-070185 (10/18/65) PAGE 1 <br /> N_., �.E <br />