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STATE IO NUMBER 00000059169 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> F( 1 01 NEW PERMIT ( 1 05 RENEWED PERMIT 0 ANK CLOSED X44-09 DELETE FROM FILE (NO FEE) <br /> ( l 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( 1 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COP.POPATION.INDIVIDUAL OR PUBLIC AGENCY) <br /> f DELTA INVESTMENT GROUP PUBLIC AGENCY ONLY <br /> ( ) 01 FED ( 7 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY <br /> STATE ZIP <br /> 808 EVERTCOURTL00I CA 95240 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> GLEN FREIH'S ARCO GLENN FREIH <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1301 W. LOCF,EFORD ST. HAM LANE <br /> CITY COUNTY <br /> ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 1301 W. LOCKEFORD ST. LODI CA 95240 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-368-5689 (X) 01 GASOLINE STATION f ) 02 OTHER <br /> NUMBER. OF/CONTAINERS 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/AREA CODE <br /> SNIDER, 4PHN_ f - 209-333-0900 _ <br /> C r <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK [ 1 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR.INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 3000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: f ) 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 /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( 1 04 DIESEL ( ) 05 WASTE OIL (X) 06 OTHER UNKNOWN <br /> V CONTAINER CONSTRUCTION <br /> Cb <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1/4 ( 7 GAUGE (X) INCHES ( ) CM ( ) UNKNOWN <br /> B. ( 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL l ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( l 05 CONCRETE <br /> [ ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( 1 10 NON-METALLIC <br /> ! ) 12 UNKNOWN f ) 13 OTHER: <br /> MSC04-070185 (10/18/85) <br /> PAGE 1 <br />