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STATE ID NUMBER 00000037663002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( 1 O1 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> f l 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> MICHAEL BISENGA ( ] 01 FED t ] 02 STATE t ) 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 /> STREET ADDRESS NEAREST CROSS STREET <br /> 17300 ELSHOLZ MURPHY RD <br /> CITY COUNTY ZIP <br /> RIPON SAN JOAQUIN 95366 <br /> MAILING ADD-ESS CITYST ATE ZIP <br /> 17300 ELSHOLZ RIPON CA 95366 <br /> PHONE W/AREA CODE TYPEOF BUSINESS <br /> 209-599-4548 ( ) 01 GASOLINE STATION (X) 02 OTHER AGRIC <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGESECT'ON <br /> 3 14 8E 33 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAM (LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE WAREA CODE <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 ( ) 04 OTHER: CONTAINER NUMBER 2 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> 0. CONTAINER CAPACITY: 250 GALLONS ( 1 UNKNOWN E. DOES THE CONTAINER STORE: f l 01 WASTE ( 7 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 /> l ) 01 UNLEADED ( ) 02 REGULAR f ] 03 PREMIUM ( ) 04 DIESEL ( ) OS WASTE OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (XI 02 SINGLE WALLED l 1 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS l ) 04 POLYVINYL CHLORIDE f l 05 CONCRETE <br /> ( ) 06 ALUMINUM l ) 07 STEEL CLAD l ] 08 BRONZE ( ) 09 COMPOSITE l ) 10 NON-METALLIC <br /> 1 ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />