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f; <br /> l e STATE ID NUMBER 00000016590002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> r O1 NEW PERMIT ( l 05 RENEWED PERMIT ( ) 07 TANK CLOSED <br /> ( ) 09 DELETE FROM FILE (NO FEE) <br /> CHANGE <br /> ( 7 02 CONDITIONAL PERMIT t ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (N0 SURCHARGE) <br /> I OWNER <br /> PUBLIC AGENCY ONLY <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) ( ) O1 FED ( ) 02 STATE ( ) 03 LOCAL <br /> DELTA PACKING COMPANY OF LODI <br /> CITY STATE ZIP <br /> STREET ADDRESS LODI CA 95240 <br /> 5950 EAST KETTLEMAN LANE <br /> II FACILITY <br /> DEALER/FOREM.AN/SUPERVISOR <br /> FACILITY NAME CARL ELKINS <br /> DELTA PACKING COMPANY OF LODI <br /> NEAREST CROSS STREET <br /> STREET ADDPESS WELLS LANE <br /> 5950 EAST KETTLEMAN LANE <br /> COUNTY ZIP <br /> CITY <br /> LODI SAN JOAQUIN <br /> CITY 95240 <br /> MASLMAILINGADDRESS STATE ZIP <br /> 5950 EAST KETTLEMAN LANE LODI CA 95240 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-334-1023 ( ) 01 GASOLINE STATION ( 02 OTHER COLD STORAGE PLANT <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> 2 1- 1 1 ::d <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/APEA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> CARL ELKINS 209-334-1023 CARL ELKINS 209-1 e-.3.�3 - 8e1-7 7 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 2 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1955 ( 7 UNKNOWN <br /> D. CONTAINER CAPACITY: 8000 GALLONS ( ] 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 /> (X) 01 UNLEADED ( 102 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f ) GAUGE f ) INCHES (X) CM l ] UNKNOWN <br /> S. ( l 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( l 03 LINED <br /> D. ( 1 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 103 FIBERGLASS f ) 04 POLYVINYL CHLORIDE t 1 05 CONCRETE <br /> ( ) 06 ALUMINUM l ) 07 STEEL CLAD ( ) 08 BRONZE f ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />