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• ,/ STATE ID NUMBER 00000012656001 <br /> APPLICATION FOR PERMIT TOOPERATE UNDERGROUND STORAGE TANK <br /> ANK ED t 09 DELETE FROM FILE (NO FEE) <br /> ( ) 01 NEW PERMIT [ ) 05 RENEWED PERMIT <br /> ( 102 CONDITIONAL PERMIT f 1 06 AMENDED PERMIT 1 08 M NOR CHA (NO SURCHARGE) <br /> OE. LOCKEFr ON.INOIVIDUAL OR PUBLIC AGENCY) J 01 FED I ) 02 STATE ( ) 03 LOCAL <br /> ECKERS OF LODI STATE ZIP <br /> cxiY CA 95240 <br /> LODI <br /> ORD ST. <br /> II FACILITY <br /> DEALER/FOREMAN/SUPERVISOR <br /> FACILITY NAME <br /> SAME ABOVE <br /> NEAREST CROSS STREET <br /> STREET ADOPESS <br /> 1235 E. LOCKEFORD ST. <br /> zxv <br /> COUNTY 95240 <br /> CITY SAN JOAQUIN <br /> LODI <br /> STATE ZIP <br /> CITY CA 95240 <br /> M41LiNG AODPESS SAME <br /> 1235 E. LOCKEFORD ST. <br /> PHONE W/AP.EA CODE <br /> TYPE OF BUSINESS <br /> ( 7 01 GASOLINE STATION (X) 02 OTHER AUTO WRECKI <br /> NG <br /> 209-368-8831 <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP <br /> RANGE SECTION <br /> 3 <br /> L <br /> 24 HOUR EMERGENCY CONTACT PERSON <br /> N-M'tLAST NAME FIRST) AND PHONE W/A P.EA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W%AREA CODE <br /> DAVIS <br /> 209-368-8831 SAME <br /> 1 J <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINE <br /> IV DESCRIPTION <br /> CONTAINER NUMBER 1 <br /> A. (X) 01 TANK ( ) 04 OTHER: <br /> B. MANUFACTURER (IF APPROPRIATE): N/A YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> ❑. CONTAINER CAPACITY: 1000 GALLONS <br /> F. DOES <br /> OIHUNLEADEDNERX) 02EREGULARVEHICLE <br /> 03FUEL <br /> PREMIUMOR WASTE 04OIL <br /> DIESEL 0( )YES <br /> 05 WASTE 2OIL (IF) 06YES <br /> OTHERK APPROPRIATE BOX(ES): <br /> V CONTAINER CONSTRUCTION <br /> FTHICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( J INCHES [ I CM (X) UNKNOWN <br /> VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( 1 02 NON-VAULTED (X) 03 UNKNOWN <br /> DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> L CHLORIDE <br /> CARBON <br /> ALUMINUML (( ]) STAINLESS <br /> S(E1 08( 03 BRONZEFIBERG095S 04 COMPOSITE POL)V10YNON-METALLIC( ) 05 CONCRETE <br /> UNKNOWN ( 1 13 OTHER: <br /> PAGE 1 <br /> HSC04-070185 (10/18/85) <br />