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TATE ID NUMBER 00000037004001 <br /> ARPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) <br /> 01 NEW PERMIT ( ] 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( 1 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR UBLIC AGENCY) PUBLIC AGENCY ONLY <br /> JDHAWW�PAULUS ( ) 01 FED ( ) 02 STATE ( 1 03 LOCAL <br /> STREET ADDRESS CITYSTATE IIP <br /> 17341 S ESCALON BELLOTA ESCALON CA 95320 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> JOHANNA PAULUS FRED PAULUS <br /> STPEET ADDPESS NEAREST CROSS STREET <br /> 17341 S ESCALON BELLATA LONE TREE <br /> CITY /� COUNTY IIP <br /> ESCALON SAN JOAQUIN 95320 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 17761 5 ESCALON BELLATA ESCALON CA 95320 <br /> PHONE W/AP.EA CODE TYPE OF BUSINESS <br /> 209-838-1784 ( ) 01 GASOLINE STATION f 1 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 2 13 9E 32 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA COCK NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/ARCA CODE <br /> PAULUS FRED 209-838-2335 PAULUS FRED 209-838-2335 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( 1 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 550 GALLONS f I UNKNOWN E. DOES THE CONTAINER STORE: l ) 01 WASTE f 102 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 /> ( 1 <br /> 01 UNLEADED ( ) 02 REGULAR ( ] 03 PREMIUM f 1 04 DIESEL f ) 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 12 (X1 GAUGE ( 1 INCHES ( ) CM ( 1 UNKNOWN <br /> S. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( 1 02 STAINLESS STEEL f ) 03 FIBERGLASS 1 ) 04 POLYVINYL CHLORIDE ( ] 05 CONCRETE <br /> ( ) 06 ALUMINUM f 1 07 STEEL CLAD 1 l 08 BRONZE ( ) 09 COMPOSITE [ ) 10 NON-METALLIC <br /> ( 1 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/8S) PAGE 1 <br />