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D NUMBER 00000051472002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT J>41107 TANK CLOSED ( DELETE FROM FILE (NO FEE) <br /> l <br /> 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARG <br /> I OWNER <br /> NAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CASE POWER & EQUIPMENT ( ) 01 FED l 1 02 STATE ( ) 03 LOCAL <br /> STPEET AOORESS CITYSTATE ZIP <br /> 880 S. BECKMAN ROAD LODI CA 95240 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/ UPERVISOR <br /> CASE POWER & EQUIPMENT LACAY-iNiG6+ �� <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 880 S. BEKMAN ROAD <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESSCITY STATE ZIP <br /> 880 S. BEKMAN ROAD LODI CA 95240 <br /> PHONE W/AREA CODE TYPE OF BVSINESS <br /> 209-3".34-w.q � ( ) 01 GASOLINE STATION (X) 02 OTHER AG TRACTOR SALES <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 2 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAT NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) ANO PHONE W/AREA CODE <br /> LARAY-AId1fi0 209+3.'.'r-54�'i SAME <br /> C E E THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): WESTERN METER YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: %3ojQD GALLONS Wl UNKNOWN E. .DOES THE CONTAINER STORE: [ 7 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES f 1 02 NO IF YES CHECK APPROPR ATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM "1 04 DIESEL ( ) 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. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED [ 1 03 LINED <br /> 0. ( ) 01 CARBON STEEL ( 1 02 STAINLESS STEEL ( ) 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD l ) 08 BRONZE f ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> 'Aw �� <br />