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\� STATE ID NUMBER 00000044597003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> Ol NEW PERMIT t 1 05 RENEWED PERMIT f 1 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEEL <br /> 7 02 CONDITIONAL PERMIT ( ) 05 RENEWED PERMIT ( 1 OB MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPOPATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> C.R. STAR INC. ( ] 01 FED ( 7 02 STATE ( 1 03 LOCAL <br /> STREET <br /> ADDRESS CITY STATE ZIP <br /> 2525 SO. HUTCHINS LODI CA 95240 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> STAR MARKET R2 BILL STEWART <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 2525 SO. HUTCHINS HARNEY LANE <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 2525 SO. HUTCHINS LODI CA 95240 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-368-0608 ( ) 01 GASOLINE STATION (X) 02 OTHER CONVENIENCE STORE <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 3 <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 CODC <br /> ROGER. FUJITA 209-369-4436 BILL STEWART 209-368-1449 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 03 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1984 ( l UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS f 1 UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (XI 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> 1 1 01 UNLEADED ( ) 02 REGULAR (X) 03 PREMIUM ( ) 04 DIESEL ( 1 05 WASTE OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1/4 f ) GAUGE (X) INCHES ( ) CM f ) UNKNOWN <br /> S. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( 1 03 LINED <br /> D. (X) 01 CARBON STEEL l ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS l 1 04 POLYVINYL CHLORIDE l ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 1 07 STEEL CLAD ( 1 08 BRONZE f ) 09 COMPOSITE ( 1 10 NON-METALLIC <br /> ( 1 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />