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STATE ID NUMBER <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ��- - <br /> _ - <br /> -- -- - —T1 1 09 DELETE FROM FILE (NO FE <br /> t�(1 <br /> 01 NEW PERMIT l } 05 RENEWED PERMIT ( ) 07 TANK CLOSED <br /> f } 02 CONDITIONAL PERMIT C 1 06 AMENDED PERMIT 1 1 0$ MINOR CHANGE (NO SURCHARGE) - -- <br /> I OWNER - - J - - <br /> _— — - -- - - - <br /> Fpt-7 <br /> DLICAGENCY ONLYNAM.E!COpPORATION.INDIVIDUAL OR FUSLIC AGENCY) 01 FED ( 1 92STAT[: 03 LOCAL <br /> BkNTA-GAPE BDNATRRIGAT-ION—DIS-T-,T�' tXTY STAT ZIP <br /> STREET AD^RESS <br /> Tr -- -�Ca 9537t�-- <br /> __.. 8880--we-st --T,i-ane- <br /> II FACILITY — — - --- -- <br /> -- � —�---- - DEALER/FOREMENISVPEPVISOP <br /> FACILITY NAME <br /> Fred E. Terrill. Jr. _-- <br /> NEAREST CROSS STREET <br /> STREET AOG'ESS <br /> Same _kjQARjHU2 ROAD - <br /> COUNTY ZIP <br /> CITi <br /> Same SAN jOAQUIN <br /> CITY STATE ZIP <br /> €: MAILING ADDPESS <br /> F. 0. Box 299 Tr n e5317-6 — <br /> PHONE W,AFEa CDDE =T�PE ®USINr55 <br /> GASOLINE STATION (XI 02 OTHER Irrigation Service <br /> -209-- X - <br /> RL1R'ALAR.EAS ONLY TO 4—�PANGE-^..__-- SECTION --- v----'— <br /> NUrDER CF C7NTPINEcS -_- <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> �. ..------ ----_-- -. T--- ---------�– -----J— F_.-- NIGHTS: NAME1 LAST NAME FIRST) AND PHONE WIAREA COOF —� <br /> 'DAYS: NAMEfLAST NAME FIRST) AND PHONE W/APER CODE <br /> Fred E. Terrill� l 209. $35-4570 Terrill, Fred. <br /> COMPLETE THE FOLLOW114G ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. ISO 1 01 TANK [ } 02 OTHER: - CONTAINER NUNbER - <br /> - PPROI'RIATE} YEAR MFG= C. YEAR INSTALLED ( } UNKNOWN <br /> B. MANUFACTURER SIF A ,J MCC�IAtC�leTl INC - --���--' <br /> D. CONTAINER CAPACITY._ZrG(& GALLONS ( 1THE CONTAINER STORE- i 1 01 WASTE (x) 02 PRODUCT G a S <br /> F. ODE THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (XI 01 YES ( 1 02 NO IF YES CHECK APPROPRIATE BOX(ES)= <br /> C 01 UNLEADED C } 02 REGULAR ( } 03 PREMIUM C } 04 DIESEL ( 1 05 WASTE OIL t } 06 OTHER- <br /> V CONTAINER CONSTRUCTION ------ <br /> A. THICKNESS OF PP.IMARY CONTAINPIENT: ( I GAUGE V'1 INCHES ( } CM [ } UNKNOWN - - <br /> IB, t 1 01 VAULTED (LOCATED IN All UNOERGROU1tD VAULT -(,<1 02 NON-VAULTED ( } 03 UNKNOWN -� <br /> 1C. 1 O1 DOUBLE WILLED C 1 02 SINGLE WALLED l } 03 LINED - --- <br /> 0. -1--41 CARSON STEEL ( 1 02 STAINLESS STEEL C 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE [ 1 05 CONCRETE <br /> I f ] 0+ ALUMINUM ( 1 07 STEEL CLAD C 1 Otj B2011Zf f 1 09 COMPOSITE C ) 10 NON-METALLIC <br /> ( 1 12 UNKNOWN ( 1 13 OTHER - - -- --_ --- _–_ -_-_�------ - - <br /> - - - -- -- ---- PAGE 1 <br /> )45C04-070185 <br />