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STATE I0 NUMBER 00000038165003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) 01 NEW PERMIT ( l 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( 1 02 CONDITIONAL PERMIT ( ] 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> JOELS S. DIETS. SHAD L. DIETS f 1 01 FED f 1 02 STATE l ) 03 LOCAL <br /> STREET ADDRESS CITYSTATE ZIP <br /> 608 SIMONS ST GALT CA 95632 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> CLEMENTS AUTOMOTIVE REPAIR OLIVER RHOADES LESSEE <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 18633 HWY. 88 NEXT TO BRIE STATION <br /> CITY COUNTY ZIP <br /> CLEMENTS SAN JOAQUIN 95632 <br /> MAILING ADDRESS CITY STATE ZIP <br /> BOX 314 CLEMENTS CA 95632 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-759-3705 (X) 01 GASOLINE STATION f ) 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 4 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/ARCA CODE <br /> OLIVER RHOADES 209-274-4402 SAME - <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 3 <br /> B. MANUFACTURER (IF APPROPRIATE): ?????????????????????????????? YEAR MFG: ???? C. YEAR INSTALLED 1978 ( ) UNKNOWN <br /> 0. CONTAINER CAPACITY: 1980 GALLONS ( l UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE ( ) 02 PRODUCT <br /> F. DOES THE CONTAIN TORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL t ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. (X) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( ) 03 LINED <br /> D. f ] 01 CARBON STEEL ( l 02 STAINLESS STEEL l 1 03 FIBERGLASS 1 1 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM (X) 07 STEEL CLAD ( ) 08 BRONZE f ) 09 COMPOSITE f 1 10 NON-METALLIC <br /> ( l 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />