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Q�PL STATE ID NUMBER 00000010620002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> f 101 NEW PERMIT ( 1 05 RENEWED PERMIT 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( 1 02 CONDITIONAL PERMIT ( l 06 AMENDED PERMIT f E (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION.ZNOIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> WESTERN METER SERVICE, INC ( ) O1 FED ( ) 02 STATE ( 1 03 LOCAL <br /> STREET ADDRESS CITYSTATE ZIP <br /> 1551 E. EIGHT MILE RD LODI CA 95240 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> WESTERN METER SERVICE, INC ROLAN OLSON <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1551 E EIGHT MILE RD WEST LANE <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESSCITY STATE ZIP <br /> 1551 E EIGHT MILE RD LOOI CA 95240 <br /> PHONE W/APER CODE TYPEOF BUSINESS <br /> 209-948-6124 ( ) 01 GASOLINE STATION (X) 02 OTHER CONTRACTOR <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGF SECTION <br /> 2 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> 04YS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> OLSON, ROBIN - - 209-948-0124 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 001 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1971 C. YEAR INSTALLED 1971 f ) UNKNOWN <br /> D. CONTAINER CAPACITY: 4000 GALLONS ( ] UNKNOWN I E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? IX) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED lX) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( l 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION o <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 3/16 ( ) GAUGE (X) INCHES ( ) CM ( ) UNKNOWN <br /> B. [ 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED (XI 02 SINGLE WALLED ( ) 03 LINED <br /> D., f ) 01 CARBON STEEL f ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE f ) 09 COMPOSITE f ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN (X) 13 OTHER: MILD STEEL <br /> HSC04-070185 (10/18/85) PAGE 1 <br />