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' STATE 10 NUMBER 00000037004002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( 1 <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> f l 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CCRPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> JOHANNA PAULUS ( l O1 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STAT! IIP <br /> 17341 S ESCALON BELLOTA ESCALON CA 95320 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> JOHANNA PAULUS FRED PAULUS <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 17341 S ESCALON BELLATA LONE TREE <br /> CITY COUNTY IIP <br /> ESCALON SAN JOAQUIN 95320 <br /> MAILING ADDRESS CITY STATE IIP <br /> 17761 S ESCALON BELLATA ESCALON CA 95320 <br /> !NUMBE:R :0F:CONTAINERS <br /> ONE W/AREA CODE TYPE OF BUSINESS <br /> 9-838-1784 ( ) O1 GASOLINE STATION [ ) 02 OTHER <br /> RURAL ARIAS ONLY TOWNSHIP RANGE SECTION <br /> 1S 9E 32 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODENIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> PAULUS FRED 209-836-2335 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 2 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: I C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 550 GALLONS ( 1 UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE l ) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES (X) 02 NO IF YES CHECK APPROPRIATE BOX(ES1: <br /> f ) 01 UNLEADED ( ) 02 REGULAR f 1 03 PREMIUM ( ) 04 DIESEL ( 1 OS WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 12 (X) GAUGE f ) INCHES ( ) CM ( l UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (Xl 02 SINGLE WALLED f ! 03 LINED <br /> 0. (X) 01 CARBON STEEL [ ) 02 STAINLESS STEEL I 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 1 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( 1 10 NON-METALLIC <br /> I ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />