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•X STATE ID NUMBER 0000000236400f <br /> APPLICATION FOR PERMIT TO OPER ERGROUND STORAGE TANK <br /> ( ) <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( 07 TANK E ( DELETE FROM FILE (NO FEE) <br /> ( ] 02 CONDITIONAL PERMIT f ) 06 AMENDED PERMIT I. OR WANuS NO SURCHARG <br /> I OWNER <br /> NAME(COPPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> JIM THORPE OIL INC. ( ) O1 FED ( ) 02 STATE f 1 03 LOCAL <br /> STREET ADDRESS CITYSTATE ZIP <br /> 351 N BECKMAN R0. LOOI CA 95240 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> KEYLOCK LOCATION RICHARD THORPE <br /> STREET ADOPESS NEAREST CROSS STREET <br /> 421:-S--BEMTR7it'rt7C � Hc.I,D)Z,p„ ;' rit. l�-. <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESS CITY STATE ZIP <br /> Gve"C.[ I LODI CA 95241 <br /> PHONE W/AREA CODE TYPE OF BUSSNESS <br /> 209-368-6175 (X) 01 GASOLINE STATION ( ) 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/APEA CODE <br /> JIM THORPE 209-368-6175 RICHARD THORPE 209-369-7440 <br /> - oto <br /> rTflTF LE TE THF"FQ777MING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 3 <br /> B. MANUFACTURER (IF APPROPRIATE): PERKINS YEAR MFG: 1965 C. YEAR INSTALLED 1965 f 1 UNKNOWN <br /> D. CONTAINER CAPACITY: 2000 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 /> (X) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 3/16 ( ) GAUGE (X) 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 f l 03 LINED <br /> D. (X) 01 CARBON STEEL ( 1 02 STAINLESS STEEL f 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( 1 OB BRONZE ( ] 09 COMPOSITE f ) 10 NDN-METALLIC <br /> f ) 12 UNKNOWN f 1 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />