Laserfiche WebLink
STATE ID HUMBER <br />APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br />11 NEW PERMIT l 1 05 RENEWED PERMIT l 1 07 TANK CLOSED ( ) 09 OELETC'FROM FILE (NO FEE) <br />1 02 COttDITIONAL PERMIT 1 1 06 AMENDED PERMIT ( 1 08 MINOR CHANGE IND SURCHARGE) <br />I OWNER <br />NAME(COPPORATION,I <br />STPEET ACnPESS <br />II FACILITY <br />FACILITY NAME <br />IVIOUAL OR I� PUBLIC AGENCY) <br />^Ca A.-4raIg j ... <br />STPEET ACCESS <br />CITY _ , f <br />MAILING ADDP Sor <br />PHONE W•ACEA COD <br />2� <br />NUYBEP CF CONTAINERS <br />CI <br />PUBLIC AGENCY ONLY <br />1 1 01 FED 1 ) 02 STATE ( 1 03 LOCAL <br />STATER ZIP JA <br />DEALER/FOPEMEN/SUPERVISOP <br />--moo Ae rrin eAfoh <br />NEAREST CROSS STREET <br />COUNTY T <br />SGA.4n <br />o a i <br />Sc T <br />TYPE CF BUSINESS <br />VA 01 GASOLINE STATION ( 1 02 OTHER <br />At AREAS ONLY )TOWNSHIP RANGE <br />III 24 HOUR EMERGENCY CONTACT PERSON <br />ZIP <br />93'20.- <br />SECTION <br />29v Y6 ;2 -- <br />)AYS: NAME( LAST <br />NAME FIPST) <br />AND PHONE W/APER BODE <br />l <br />NIGHTS: <br />NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br />C. YEAR INSTALLED <br />I y �1— () UNKNOWN_ <br />LLONS ( 1 UNKNOWN <br />0. CONTAINER CAPACITY:�MOTOR <br />E. DOES THE CONTAINER <br />STORE: ( 1 01 WASTE <br />COMPLETE THE FOLLOWING ON A SEPARATE FURM FUR tA(:H CUMIAlntK <br />IV DESCRIPTION <br />A. (�1 AIIK ( 1 02 OTHER_ <br />CONTAINER NUMBER <br />l <br />B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: <br />C. YEAR INSTALLED <br />I y �1— () UNKNOWN_ <br />LLONS ( 1 UNKNOWN <br />0. CONTAINER CAPACITY:�MOTOR <br />E. DOES THE CONTAINER <br />STORE: ( 1 01 WASTE <br />( 1 02 PRODUCT <br />F. DOES THE CONTAINER EHj��; LE FUEL OR WASTE OIL ?�S <br />1 1 02 NO If YES CHECK <br />APPROPRIATE BOXIEST: <br />( 1 01 UNLEAOEO ( 1 02 REGULAR l/Xl 03 PP EMIUM ( ) 04 DI L ( 1 05 <br />WASTE OIL 4m 6 OTHER <br />V CONTAINER CONSTRUCTION <br />A. THICKNESS OF PP.IMARY CONTAINMENT: 0. 7 GAUGE ( INC ES <br />( 1 CM I 1 UNKNOWN <br />B. ( 1 01 VAULT EO (LOCATED IN AN UNOERGROUND VAULT) (X1l_,. NON -VAULTED <br />( l 03 UNKNOWN <br />IC. 1 1 01 DOUBLE WILLED ( INGLE WALLED 1 1 03LINED <br />D. l 1 01 CARBON STEEL l 1 02 STAINLESS STEEL ( 16ERGLASS ( 1 04 <br />POLYVINYL CHLORIDE l <br />105 CONCRETE <br />( 1 06 ALUMINUM I 1 07 STEEL CLAD ( 1 BROIIZE 1 1 09 COMPOSITE <br />( 110 NON-METALLIC <br />l I 12 UNKNOWN ( 1 13 OTHER: <br />------------------ ----- <br />HSC04-070185 <br />PAGE 1 <br />