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STATE I0 NUMBER 00000024244001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> f ) 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> f 1 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> GERARD WESTSTEYN f ) 01 FED f ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 22072 S. JACKTONE RD. RIPON CA 95366 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> GERARD WESTSTEYN <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 22072 S. JACKTONE RD. 99 HIWAY <br /> CITY COUNTY IF <br /> RIPON SAN JOAQUIN 95366 <br /> MAILING ADDRESSCITY STATE ZIP <br /> 22072 S. JACKTONE RD. RIPON CA 95366 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-599-4458 ( ) 01 GASOLINE STATION (XI 02 OTHER FARM <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/ARCA CODE <br /> WESTSTEYN, GERARD 209-599-4458 WESTSTEYN, GERARD 209-599-4458 <br /> COMPLETE 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): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> 0. CONTAINER CAPACITY: 250 GALLONS f 1 UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE ( ) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES (X) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> 1 ) 01 UNLEADED f 1 02 REGULAR ( 1 03 PREMIUM ( ) 04 DIESEL f 1 05 WASTE OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( l INCHES f ) CK (X) UNKNOWN <br /> B. f 101 VAULTED (LOCATED IN AN UNDERGROUND VAULT) f ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( I 01 DOUBLE WALLED ( l 02 SINGLE WALLED ( ) 03 LINED <br /> 0. f ) 01 CARBON STEEL f ) 02 STAINLESS STEEL f ) 03 FIBERGLASS l ) 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> ( ) 06 ALUMINUM f ) 07 STEEL CLAD ( 1 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( 1 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> `s 1-.0 +llor <br />