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STATE ID NUMBER v0000000236096 <br /> APPLICATION FOR PERMIT TO OPE RGROUND STORAGE TANK <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT TANK CLOSED 9 DELETE FROM FILA (NO FEE) <br /> 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( OR CHANGE (NO SURCHAR ) 0 <br /> I OWNER <br /> NAME(CORPOPATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AG LY <br /> .JIM THORPE OIL INC. f ). 01 FE ( 102 ^PYA ( ) 03 LOCAL <br /> STREET ADDRESS CITY S AT ZIP <br /> 351 N BECKMAN RD. LODI A .95240 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> KEYLOCK LOCATION RICHARD THORPE <br /> STREET ADDRESS ' NEAREST CROSS STREET - <br /> -4fi—S-CHd1 RA, AVE eYYRA r.,�._..� T <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN ._ 95240 <br /> MAILING ADDRESS CITY STATE ZIP <br /> FCL(I)IT) <br /> CA 95241 ^0 3 S) <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-368-6175 (X) 01 GASOLINE STATION ( ) 02 OTHER <br /> NUMBER OF CONTA,7.H ERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> lDAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> 4iYTRORPC /40v0j A! 'r 9 NG Z-7_33Ir-Q RICHARD THORPE 209-369-7440 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER <br /> B. MANUFACTURER (IF APPROPRIATE): PERKINS YEAR MFG: 1965. C. YEAR INSTALLED 1965 f ) UNKNOWN <br /> D. CONTAINER CAPACITY: 4000 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 ( 1 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL l 1 05 WASTE OIL ( 7 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 3/16 ( ) GAUGE (X) INCHES ( ) CM f ) UNKNOWN <br /> B. f ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( 1 02 STAINLESS STEEL ( l 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( ) 30 NON-METALLIC <br /> f ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />