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STATE ID NUMBER 00000050409001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( 1 <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT 1 07 TANK CLOSED09 DELETE FROM FILE (NO FEE) <br /> t ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ) yl <br /> OB MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAM!(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> WESTERN ASPHALT SERVICE, INC. f ) 01 FED ( ) 02 STATE ( 1 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 3003 FAIRHAVEN BAKERSFIELD CA 93308 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> LODI FACILITY (WESTERN ASPHALT JAMES FRESHOUR <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 19256 NO. HWY 99 HWY 99 <br /> CITY <br /> COUNTY ZIP <br /> LODI SAN JOAQUINHE 95240 <br /> M.AILIN3 ADDRESS CITY <br /> STATE ZIP <br /> 3003 FAIRHAVEN BAKERSFIE LD CA 93308 <br /> CODE TYPE OF BUSINESS <br /> 805-327-0413 ( 1 01 GASOLINE STATION (X) 02 OTHER ASPHALT STORAGE <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> 1 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAM! FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> JAMES FRESHOUR 209-333-1506 JAMES FRESHOUR 209-333-1506 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK f 1 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (.IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> 0. CONTAINER CAPACITY: 20000 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 ? ( ) 01 YES (X) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL f 7 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION -.-- <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM ( 1 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 f ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS f l 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( 1 08 BRONZE f ) 09 COMPOSITE f ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) <br /> PAGE I <br /> r <br />