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L/ STATE ID NUMBER 00000048861004 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED t ) 09 DELETE FROM FILE (NO FEE) <br /> ) 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,IND IVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> Y ( ) 01 FED t ) 02 STATE [ ) 03 LOCAL <br /> STREET ADORES CITY STATE ZIP <br /> I LODI CA 95240 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SS,UrPPEERAR,,V��ISOR <br /> CHEROKEE SERVICE CENTER SER*La ..MARtr"L.4i'�IG <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 303 S. CHEROKEE LODI AVE. <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESSC CITY STATE ZIP <br /> a ru� LODI CA 95240 <br /> PHONE W/AREA COD TYPEOF BUSINESS <br /> 209-m4-um 7� 7f -�Q^J�' (X) Ol GASOLINE STATION f l 02 OTHER <br /> NUMBER OF COM-1-NE-PS RURAL ARIAS ONLY TOWNSHIP RANGE SECTION <br /> 4 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CGDE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> 209-369-7B.1 -- FIGWARD:OERAt•D 2D9 =-: ~_�fT177 a�� <br /> C,41tftL( uo_�t�L.. <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK t ) 04 OTHER: CONTAINER NUMBER 3 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED lX] UNKNOWN <br /> D. CONTAINER CAPACITY: 8500 GALLONS ( l UNKNOWN E. DOES THE CONTAINER STORE: f 1 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 /> l 101 UNLEADED l ) 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL ( 1 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( 1 GAUGE f 1 INCHES t ) CM (X) UNKNOWN <br /> B. ( ) Ol VAULTED (LOCATED IN AN UNDERGROUND VAULT) !fJ 02 NON-VAULTED (*r-03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ] 02 SINGLE WALLED ( 1 03 LINED <br /> D. (X) 01 CARBON STEEL f l 02 STAINLESS STEEL ( ] 03 FIBERGLASS ( ] 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( 1 06 ALUMINUM ( 1 07 STEEL CLAD ( 1 08 BRONZE ( 1 09 COMPOSITE f 1 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />