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%.' <br /> ' 1.00, STATE ID NUMBER 00000058626004 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> �[) <br /> 01 NEW PERMIT l l 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( 1 09 DELETE FROM FILE (NO FEE) <br /> ( 7 02 CONDITIONAL PERMIT ( ! 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION.IND IDUAL OR PVD IC AOENC 7 PUBLIC AGENCY ONLY <br /> ROBERT 0. SCHULZ AA 01 FED ( l 02 STATE f 1 03 LOCAL <br /> STREET ADDRESS CITYSTATE ZIP <br /> 1702 JACKSON ST. �tAtiL(fv r ESCALON CA 95320 <br /> II FACILITY <br /> FACILITY NAME DEA /F REMAN/ UPFAVISOR <br /> BOB'S UNION SERV. \J <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1702 JACKSON ST. CALIF. <br /> CITY COUNTY ZIP <br /> ESCALON SAN JOAQUIN 95320 <br /> MAILING ADDRESS CITYSTATE ZIP <br /> 1702 JACKSON ST. ESCALON CA 95320 <br /> PHONE W/.4 REA CODE TYPE OF BUSINESS <br /> 209-838-7320 (X1 01 GASOLINE STATION ( ) 02 OTHER <br /> NUMBER ZC7 <br /> NTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <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 /> SCHULZ, ROBERT 209-838-3115 SAME - <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 4 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 2000 GALLONS l ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES)( <br /> ( ) O1 UNLEADED I ) 02 REGULAR (X) 03 PREMIUM ( 1 04 DIESEL f ) 05 WASTE OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN - <br /> C. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( 1 03 LINED <br /> D. ( ) 01 CARBON STEEL f 1 02 STAINLESS STEEL I ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( l 05 CONCRETE <br /> ( ) 06 ALUMINUM [ ) 07 STEEL CLAD ( 1 08 BRONZE f ) 09 COMPOSITE ( 1 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />