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`w \aw STATE ID NUMBER 00000036542001 <br />APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br />( ) 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br />( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br />OWNER <br />4AME(CORPORATION.IN0IVIOUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br />)HILIP CHINCHIOLO 6 SONS ( ) 01 FED ( ) 02 STATE ( 1 03 LOCAL <br />:TREET ADDRESS CITY STATE ZIP <br />?0848 E. RIVER RD RIPON CA 95366 <br />TT FACILITY <br />FACILITY NAME <br />(X) 01 TANK ( ) 04 OTHER: <br />DEALER/FOREMAN/SUPERVISOR <br />CONTAINER NUMBER 1 <br />PHILIP CHINCHIOLO S SONS <br />MANUFACTURER (IF APPROPRIATE): <br />STEVE CHINCHIOLO <br />C. <br />STREET ADDRESS <br />0. <br />NEAREST CROSS STREET <br />E. DOES THE CONTAINER STORE: f <br />SOUTH BRENNA14 RD <br />F. <br />ULLREY AVE <br />IF YES CHECK APPROPRIATE SOX(ES): <br />( ) 06 OTHER <br />CITY <br />POLYVINYL CHLORIDE ( ) 05 CONCRETE <br />( ) 10 NON-METALLIC <br />COUNTY <br />ZIP <br />ESCALON <br />SAN JOAQUIN <br />95320 <br />MAILING ADDRESS <br />CITY <br />STATE <br />ZIP <br />20848 E RIVER RD. <br />RIPON <br />CA <br />95366 <br />D <br />PHONE W/AefA CODE <br />TYPE OFBUSINESS <br />209-599-2927 <br />f 1 01 GASOLINE STATION (X) 02 OTHER <br />NUMBER OF CONTAINERS <br />RURAL AREAS ONLY <br />TOWNSHIP <br />RANGE <br />SECTION <br />1 <br />23 <br />9E <br />7 <br />III 24 HOUR EMERGENCY CONTACT -PERSON <br />)AYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIOHTS: NAME(LAST NAME FIRST) AND PHONE W/AR!A CODE <br />:HINCHIOLO STEVE 209-599-2927 CHINCHIOLO STEVE 209-599-2927 <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. <br />(X) 01 TANK ( ) 04 OTHER: <br />( ) INCHES <br />CONTAINER NUMBER 1 <br />S. <br />MANUFACTURER (IF APPROPRIATE): <br />YEAR MFG <br />C. <br />YEAR INSTALLED (X) UNKNOWN <br />0. <br />CONTAINER CAPACITY: GALLONS (X) UNKNOWN <br />E. DOES THE CONTAINER STORE: f <br />) 01 WASTE ( ) 02 PRODUCT <br />F. <br />DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES ( ) 02 NO <br />t ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL <br />IF YES CHECK APPROPRIATE SOX(ES): <br />( ) 06 OTHER <br />V CONTAINER CONSTRUCTION <br />A. <br />THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE <br />( ) INCHES <br />( ) CM (X) UNKNOWN <br />B. <br />( ) <br />01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) l ) 02 <br />NON -VAULTED <br />(X) 03 UNKNOWN <br />C. <br />( ) <br />01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( ) 03 LINED <br />D. <br />( ) <br />(X) <br />01 CARBON STEEL ( ) 02 STAINLESS STEEL [ 103 FIBERGLASS l 1 04 <br />( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( 1 08 BRONZE ( 1 09 COMPOSITE <br />12 UNKNOWN ( ) 13 OTHER: <br />POLYVINYL CHLORIDE ( ) 05 CONCRETE <br />( ) 10 NON-METALLIC <br />. HSC04-070185 (10/18/85) <br />,*O.W tit <br />PAGE 1 <br />