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STATE ID NUMBER 00000066266001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 06 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 /> I OWNER <br /> NAME(CON PORATION.IND IVIDUA L OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> SAN JOAQUIN COUNTY C"WBRK- I( ) 01 FED ( ) 02 STATE Od 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> N-9N--e'blr STOCKTON CA 95200'2- <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> HARNEY LANE LANDFILL KEN BELCHER <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 14750 E. HARNEY LANE JACKTONE <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESS CITY STATEZIP <br /> P.O. BOX 1810 STOCKTON CA 95201 <br /> PHONE W/AREA CODE TYPEOF BUSINESS <br /> 209-944-2275 ( ) 01 GASOLINE STATION (X) 02 OTHER SOLID WASTE DISPOSAL <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 1 <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/AREA CODE <br /> *WHORTONA Tdm 209-944-2275 *f*BELCHER), KaW1 209-823-3602 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMSER.,Y <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1976 ( 1 UNKNOWN <br /> D. CONTAINER CAPACITY: 5000 GALLONS ( 1 UNKNOWN E. DOES THE CONTAINER STORE: wecl WASTE W 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ('d 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( 1 01 UNLEADED ( 1 02 REGULAR ( 1 03 PREMIUM 0d 04 DIESEL ( ) 05 WASTE OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: l ) GAUGE yP<INCHES ( ) CM 00-UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED 02 SINGLE WALLED ( ) 03 LINED <br /> 0. (4 01 CARBON STEEL ( 102 STAINLESS STEEL ( 103 FIBERGLASS f 1 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> I ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) OB BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> 12 UNKNOWN ( 1 13 OTHER: <br /> HSC04-070185 (08/29/86) PAGE 1 <br />