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STATE ID NUMBER 00000008785001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> I ( 1 O1 NEW PERMIT ( ) 05 RENEWED PERMIT 7C4 07TANK OS <br /> CLED ( 1 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( ] 06 AMENDED PERMIT ( 1 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COP.PORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> MARY LEHR 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 1250 EDGEWOOD DRIVE LODI CA 95240 <br /> II FACILITY <br /> U FACILITY NAME NAME OEALEP/FOREMAN/SVP E.R VISOR IjQ. <br /> GLASS SERVICE OF LODI JAMES R. GARECHT <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 200 E. LODI AVE. STOCKTON STREET U <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESS CITY STATE ZIP <br /> SAME AS ABOVE SAME 95240 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-368-5321 ( ) 01 GASOLINE STATION (X) 02 OTHER GLASS <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY . TOWNSHIP RANGE SECTION <br /> 1 <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 /> }kMEy-R--6ARg2CH{ gpy�� <br /> JAMES R. GA*LCm - ' <br /> COMPLETE THE FOLLOWING ON A SEPARATE iFORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER #906640-7- <br /> 6. MANUFACTURER (IF APPROPRIATE): TOKHEIM PUMP YEAR MFG: C. YEAR INSTALLED 1957 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 500 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: f 1 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 f 1 04 DIESEL ( ) 05 WASTE OIL f 7 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( 1 CM (X) UNKNOWN <br /> B. ( 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. 1 01 DOUBLE WALLED ( 1 0.2 SINGLE WALLED ( 7 03 LINED <br /> 0. ( ) 01 CARBON STEEL ( l 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( l 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD f ) 08 BRONZE ( 1 09 COMPOSITE f ] 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) . PAGE 1 <br /> 0 0 <br />