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i� • ' <br /> STATE IO NUMBER 00000016769003 <br /> FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( 1 <br /> 01 NEW PERMIT ( 1 05 RENEWED PERMIT TANK CLOSED - Ac 09 DELETE FROM FILE (NO FEE 1� <br /> ( ) 02 CONDITIONAL PERMIT 1 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPOPATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> RIPON FARM SERVICE ( ) 01 FED ( ) 02 STATE ( l 03 LOCAL <br /> STPE!T PDORESS CITU STATE ZIP <br /> HWY 99 & JACKTONE RD RIPON CA 95366 <br /> II FACILITY <br /> FACILIT'i NAM! DEALEP/FOREMAN/SUFEPVISOR <br /> RIPON FARM SERVICE BUD DENOUDEN <br /> STFEET ACOPESS NEAREST CROSS STREET <br /> HWY 99 & JACKTON RD. <br /> CITY COUNTY ZIP <br /> RIPON SAN JOAQUIN 95366 <br /> "°)LING AODPESS CITY STATE ZIP <br /> PO BX 786 RIPON <br /> CA 95366 <br /> PHOS! APIA CODE TYPE CF BUSINESS <br /> 209-599-2188 ( ) O1 GASOLINE STATION (X) 02 OTHER AGR. CHEM & FERT. SA <br /> NVMBEP OF C NTAINEPS PUPAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> 1- <br /> D-IS: NIM=_( LAST NAME FIRST) AND PHONE W/APEA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> DENOUDEN, BUD 209-599-2761 SAME <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. f ) 01 TANK (X) 04 OTHER: SUMP CONTAINER NUMBER 3 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> 0. CONTAINER CAPACITY: 18000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: 1X1 01 WASTE ( ) 02 PRODUCT <br /> iF. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? l 1 01 YES (X) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( 1 04 DIESEL ( ) 05 WASTE OIL f l 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> THICKNESS OF PRIMARY CONTAINMENT: l ) GAUGE ( ) INCHES ( ) CM ( ) UNKNOWN <br /> 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> j , <br /> C. ( 1 01 DOUBLE WALLED ( 1 02 SINGLE WALLED 06 03 LINED f ,fr il"'e <br /> D. f 1 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE (XI 05 CONCRETE <br /> f ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( l 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( 1 13 OTHER: <br /> ISC04-070185 (10/18/85) PAGE 1 <br />