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STATE IO NUMBER 0000001891 <br /> APPLICATION FOR PERMIT TO OPERA UNDERGROUND STORAGE TANK <br /> 1 1 01 NEW PERMIT ( ) 05 RENEWED PERMIT NK CLOSE ( 1 09 DELETE FROM FILE (NO 1 <br /> ( ) 02 CONDITIONAL PERMIT f ) 06 AMENDED PERMIT _101 08 MINOR E (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> ESCALON LUMBER S HARDWARE INC ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STAT! IIP <br /> 1455 FIRST ST. ESCALON CA 95320 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> ESCALON LUMBER B HARDWARE INC <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1455 FIRST ST. <br /> CITY COUNTY IIP <br /> ESCALON SAN JOA:QUIN 95320 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 1455 FIRST ST. ESCALON CA 95320 <br /> PHONE W/AREA CODE TYPEOF BUSINESS <br /> 209-838-7337 ( ) 01 GASOLINE STATION (X) 02 OTHER LUMBER i HARDWARE <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY 1 TOWNSHIP RANOE SECTION <br /> I <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/APEA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> MARVIN F. SCHMIDT 209-838-7337 - <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER R1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> 0. CONTAINER CAPACITY: 1000 GALLONS ( l UNKNOWN) E. DOES THE CONTAINER STORE: f ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(E5): <br /> ( 1 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL l 1 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES. ( 1 CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( l 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( 102 SINGLE WALLED ( ) 03 LINED <br /> U. (X) 01 CARBON STEEL f ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( l 05 CONCRETE <br /> [ ) 06 ALUMINUM ( ) 07 STEEL CLAD ( 1 08 BRONZE ( ) 09 COMPOSITE ( 1 10 NON-METALLIC <br /> f ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> bow \f <br />