Laserfiche WebLink
`. 3z6 <br /> STATE ID NUMBER 00000037663001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> f ) <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT f ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEEL <br /> . ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPOPATION,INOIVIDUAL OR PUBLIC AOENCY) PUBLIC AGENCY ONLY <br /> MICHAEL BISENGA ( ) 01 FED ( ) 02 STATE ( 1 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 17300 ELSHOLZ RIPON CA 95366 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> MICHAEL EISENGA MICHAEL EISENGA <br /> STP!ET ADOPESS NEAREST CROSS STREET <br /> 17300 ELSHOLZ MURPHY RD <br /> CITY COUNTY ZIP <br /> RIPON SAN JOAQUIN 95366 <br /> MAILING ADD P.ESS CITY STATE ZIP <br /> 17300 ELSHOLZ RIPON CA 9.5 <br /> 366 <br /> L209-599-4548 <br /> W/AREA CODE TYPE OF BUSINESS <br /> ( ) O1 GASOLINE STATION (X) 02 OTHER AGRIC <br /> OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 3 15 8E 33 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAMEt LAST NAME FIRST) AND PHONE W/APEA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA COD! <br /> EISENGA MIKE 209-599-4668 EISENGA MIKE 209-599-4568 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK f ) 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 250 GALLONS ( I UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE ( ) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES (X) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> [ ) <br /> 01 UNLEADED f ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL f 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM (X1 UNKNOWN <br /> B. f ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED fX) 02 SINGLE WALLED ( 1 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL f ! 03 FIBERGLASS ( 7 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ! 08 BRONZE f 1 09 COMPOSITE ( ) 10 NON-METALLIC <br /> f ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE, 1 <br />