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STATE ZD NUMBER 00000034919002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> l <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> l ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT T-) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CITY OF LODI ( ) 01 FED ( 1 02 STATE ) 03 LOCAL <br /> STREET ADDRESSCITY STATE ZIP <br /> 221 W. PINE ST LOBI CA 95240 <br /> II FACILITYFACILICY NAME v� L 1 _ <br /> PUBLIC TSAFETY BUILDING . p 1 �d 1 RICHARD WIECHN�j IFER s'•(0.1K1• S tr n4e"fKT <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 230 W. ELM ST CHURCH <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 221 W. PINE ST. - LODI CA 95240 <br /> PHONE W/APEA CODE TYPE OF BUSINESS <br /> ( ) 01 GASOLINE STATION (X) 02 OTHER POLICE/FIRE DEPT. <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 2 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAMECLAST NAME FIRST) AND PHONE W/AP.EA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> LODI FIRE DEPT 209-369-3521 SAME 40999 M6 209 / <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. IX) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 230-2 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1965 C. YEAR INSTALLED 1965 f ) UNKNOWN <br /> D. CONTAINER CAPACITY: 18400 GALLONS l 1 UNKNOWN E. DOES THE CONTAINER STORE: f ) 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 /> (X) 01 UNLEADED f 102 REGULAR ( l 03 PREMIUM ( ) 04 DIESEL f 1 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 5/16 ( ) 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 ( ) 03 LINED <br /> D. qG 01 CARBON STEEL f ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> 1 06 ALUMINUM ( 7 07 STEEL CLAD f ) 08 BRONZE f ] 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( 1 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> `'a �r <br />