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`, .. <br /> STATE IO NUMBER 00000058141004 <br /> ,� APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> f'(l O1 NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT f ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPOR,ATION,INOIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> LODI UNIFIED SCHOOL DISTRICT ( ) 01 FED ( ) 02 STATE ( 1-03 LOCAL <br /> STREET ADDRESS CITYSTATE ZIP <br /> 815 WEST LOCKEFORD STREET LODI CA 95240 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPER .I <br /> TRANSPORTATION DEPT. MERLE JEWETT, V)1'eC�fJt <br /> STREET AGGRESS NEAREST CROSS STREET <br /> 820 SO. CLUFF AVE. INDUSTRIAL WAY <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESS CITY STATE Z2P <br /> 815 WEST LOCKEFORD ST. LODI CA 95240 <br /> PHONE W/AREA COOS TYPE OF BUSINESS <br /> 209-3j fyb, 13 ..7 t ( ) O1 GASOLINE STATION (X) 02 OTHER SCHOOL <br /> NUMBER OF CONT, NIRS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 4 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/ EA CO E NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> JEWETT, MERLE 2II9-36 4�L6 - D JEWETT, MERLE 209-578-3258 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER D-1 <br /> B. MANUFACTURER (IF APPROPRIATE): ARROW TANK YEAR MFG: 1984 C. YEAR INSTALLED 1984 ( 1 UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( 1 01 WASTE (X) 02 PRODUCT <br /> F. D0S3?HE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> I ) 01 UNLEADED ( 1 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL l ) 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: .250 ( 1 GAUGE (X) INCHES ( ) CM ( ) 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 f 1 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 1 07 STEEL CLAD ( 1 08 BRONZE ( 109 COMPOSITE ( ) 10 NON-METALLIC <br /> I ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />