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0 0 <br /> STATE ID NUMBER 00000020285001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> (?U O1 NEW PERMIT ( ) 05 RENEWED PERMIT ( 1 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( 1 02 CON0IT20NAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGE ) PUBLIC AGENCY ONLY <br /> AWWQXRQWW,-G @,T-EMS, INC. 1.. NCYP C T T ( ) 01 FED ( 3 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS �eI /_ CITY ) STATE ZIP .j <br /> 3643-e" ERCE �.j�I ( �Q,(!" ��O(.f+�r' SAN eurnuxa �� - .+ TIA i:,. 8iSS0 <br /> II FACILITY <br /> FACILITY NAME ( DEALER/FOREMAN/SUPERVISOR ' <br /> A/Al t� <br /> Flti.fLW-FAST..#102 04 :''+ �- RANDY^+1 w'L-E HAI U I - <br /> / 1r�� <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 501W LODI HUTCHINS <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESS CITY STATE ZIP <br /> P.O_Bsxx_� T 'c &AW_AUTQMFO r- :..< rR l a. Y. X01 ,. <br /> PHONE W/AREA CODE TYPEOF BUSINESS <br /> 512-22-3-2631 (" (X) 01 GASOLINE STATION f l 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/APEA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AP.EA CODE <br /> JORBMN,—GARY 916=427-t+14 JORBAN,-4ARX 916-685-7288 <br /> 2 o,7 G 1 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( l 04 OTHER,. CONTAINER NUMBER 0i4, <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: C. YEAR INSTALLED 1972 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 4940 GALLONS f 1 UNKNOWN E. DOES THE CONTAINER STORE: f ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (XI 01 YES ( 1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> fX) Ol UNLEADED f ) 02 REGULAR ( ) 03 .PREMIUM ( ) 04 DIESEL f 7 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f 7 GAUGE ( l INCHES ( ) CM fX) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED. C0 02 SINGLE WALLED ( 1 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL f 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE f 1 05 CONCRETE <br /> f 7 06 ALUMINUM ( 1 07 STEEL CLAD ( 1 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> f l 12 UNKNOWN ( 7 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />