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[00py ft To 6 � T kt - <br /> -- STATE ID NUMBER 00000016769006 <br /> APPLICATION FOR PERMIT TO OPER T ROUND STORAGE TANK <br /> I (X) 01 NEW PERMIT f ) 05 RENEWED PERMIT07 ANK CLOSED ( 7 09 DELETE FROM FILE (NO FEE) <br /> t ( ) 02 CONDITIONAL PERMIT f ) 06 AMENDED PERMIT ?(4)108 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPORATION,INDIVIDUAL OR PUBLIC AG!NCY) PUBLIC AGENCY ONLY <br /> RIPON FARM SERVICE [PUB <br /> O1 FED f 1 02 STATE ( 1 03 LOCAL <br /> STREET ADDRESS CITYSTATE ZIP <br /> HWY 99 i JACKTONE RD RIPON CA 95366 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> RIPON FARM SERVICE BUD DENOUDEN <br /> STREET ADDRESS NEAREST CROSS STREET <br /> HWY 99 & JACKTON RD. <br /> CITY COUNTY ZIP <br /> RIPON SAN JOAQUIN 95366 <br /> S MAILING ADDRESS CITY STATE ZIP <br /> PO BX 786 RIPON CA 95366 <br /> PHONE W/APEA CODE TYPE OF BUSINESS <br /> 209-599-2188 ( ) 01 GASOLINE STATION (X) 02 OTHER AGR. CHEM 6 FERT. SA <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> b <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> 7AYS: NAM,EIIAS7 NAME FIRST) AND PHONE W/AREA CCCE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA COOK <br /> ^•-r.�-t;�- SAME - - <br /> 7D6A/AII$ Q'iTl-E <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TAMC ( ) 04 OTHER: CONTAINER NUMBER GAS-RFS <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS (X) 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 BOXIES): <br /> (X) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM f 1 04 DIESEL ( 1 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( I INCHES ( 1 CM (X) UNKNOWN <br /> B. f ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) f ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED 0() 02 SINGLE WALLED ( 1 03 LINED <br /> D. ( ) 01 CARBON STEEL ( l 02 STAINLESS STEEL f 103 FIBERGLASS f 1 04 POLYVINYL CHLORIDE ( 105 CONCRETE <br /> ( ) 06 ALUMINUM f ) 07 STEEL CLAD f 1 08 BRONZE ( 1 09 COMPOSITE ( l 10 NON-METALLIC <br /> IX) 12 UNKNOWN ( ) 13 OTHER: <br /> i; <br /> HSC04-070165 (10/18/851 PAGE 1 <br />