Laserfiche WebLink
STATE ID NUMBER <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK 77 <br /> I)CA-01 NEW PERMIT ( 1 05 RENEWED PERMIT ( 1 07 TANK CLOSED t l 09 DELETE FROM FILE (NO FEE) 1 <br /> •i" 1 1 02 CONDITIONAL PERMIT 1 1 06 AMENDED PERMIT ( 1 OB MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAH.EICORPORATION.INDIVIDUAL OR FUOLIC AGENCY) PUBLIC AGENCY ONLY <br /> 77 Ol FED 1 1 02 STATE ( ) 03 LOCAL <br /> STREL�T A"ERE'S -- cITUL.. STATE IIP <br /> II FACILITY <br /> FACIDEALER/FOP MENISUOEPVISOR <br /> . ,t3Tr/rr� ?wgsz,� <br /> STREET <br /> AICD"SS ' NEAPEST CROSS STPEET <br /> CITY COUNTY ZIP <br /> 79�__ — <br /> MAILING ADDRESS CITY STATE Z2P <br /> PHONE W-APEA CODE TYRE OF 6USINESS �- <br /> l 1 01 GASOLINE STATION ( R02 OTHER / <br /> NVMpER C• CONTAINERS RUPAL AREAS ONLY TOWNSHIP <br /> F7RANGE SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: (NC.1.11L.ST NAME FIRST) AND <br /> PPH/O�NEE W/APEA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE WIAPEA CODE 1 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. 1 <br /> 01 TANK f ) 02 OTHER: CONTAINER NUMBER ? <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED ( ) UNKNOWN <br /> D. C014TAI14ER CAPACITY: _ ao GALLONS l ) UNKNOWN E. DOES THE CONTAINER STORE: 1 1 01 WASTE JLJ2 PRODUCT <br /> F DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( 1 01 YES 1-) 02 NO IF YES CHECK APPROPRIATE BOXIEST: <br /> 01 lR)LEAD ED ( 1 02 REGULAR 1 1 03 PREMIUM IYI_04 DIESEL _ 1 1 05 WASTE OIL 1 ) 06 OTHER_ <br /> V CONTAINER CONSTRUCTION � <br /> A. THICKNESS OF PRIMARY CONTAINMENT: __ f 1 GAUGE f I INCHES f 1 CM UNKNOWN _ - -- -- - <br /> S. f ) OS VAULTED (LOCATED IN AN UNDERGROUND VAULT) (102NON-VAULTED ( 1 03 UNKNOWN <br /> C. t 1 01 DOUBLE WILLED 1 02 SINGLE WALLED 1 1 03 LINED <br /> D. CARBON STEEL t ) 02 STAINLESS STEEL 1 1 03 FIBERGLASS f 1 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( 1 06 ALUMINUM t 1 07 STEEL CLAD l 1 08 BRONZE 1 1 09 COMPOSITE ( 110 NON-METALLIC <br /> 1 1 12 UNKNOWN ( 1 13 OTHER: <br /> HSCO14-07^185 PAGE 1 <br />