Laserfiche WebLink
ST E ID NUMBER 000000OZ3&=U <br /> APPLICATION FOR PERMIT TO OPE GROUND E TANK <br /> 01 NEW PERMIT ( 1 05 RENEWED PERMIT 07 TANK C <br /> /y ELETE FROM FILE (NO FEE) <br /> ( l 02 CONDITIONAL PERMIT ( 7 06 AMENDED PERMIT ( OR CHANGE ( . HAR <br /> I OWNER <br /> NAME(CORPORATICN,INDIVIOUAL OR PUBLIC AGENCY) ' USLIC AGENCY ONLY <br /> JIM THORPE OIL INC. 21 ) 01 FED ( Y 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 351 N BECKMAN RD. LOON CA 95240 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> KEYLOCK LOCATION RICHARD THORPE <br /> STP.EET ADDRESSboo (�ey� NEAREST CROSS STP ET -�7� <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESS CITY STATE ZIP <br /> LODI CA 95241 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-368-6175 (X) 01 GASOLINE STATION ( 1 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAMI(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> JI 209-368-6175 RICHARD THORPE 209-369-7440 <br /> q&2_- 73o5 <br /> LETE THE-TTLLOWING 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): PERKINS YEAR MFG: 1965 C. YEAR INSTALLED 1965 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 4000 GALLONS ( 1 UNKNOWN E. DOES THE CONTAINER STORE: ( l 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 (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( Y 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 3/16 ( ) GAUGE OO INCHES ( ) CM ( ) UNKNOWN <br /> B. ( ) 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 ( ) 02 STAINLESS STEEL f 1 03 FIBERGLASS ( l 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE f ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ] 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> • <br /> 0 <br />