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STATE ID/NUMBER 00000059799001 <br /> APPLICATION FOR PERMIT TO OP ATE UNDERGROUND STOR E TANK <br /> 0 <br /> 1 NEW PERMIT ( ) 05 RENEWED PERMIT ( 07 TANK CLOSED <br /> ( 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( 1 08 MINOR CHANGE (NO SURCHARGE) 09 DELETE FROM FILE (NO FEE) <br /> I OWNER <br /> NAME(CORP02ATION�INDIVIOUAI OR PUBLIC AGENCY) <br /> RIPON CONSOLIDATED FIRE DEPT. PUBLIC AGENCY ONLY <br /> ( ) O1 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS <br /> 142 SOUTH STOCKTON OITY STATE ZIP <br /> RIPON CA 95366 <br /> II FACILITY <br /> FACILITY NAME <br /> RIPON CONSOLIDATED FIRE DIST. DEALER/FOREMAN/SUPERVISOR <br /> ED BYNUM (CHIEF) <br /> STREET ADDRESS <br /> R-ma-yNEAREST CROSS STREET <br /> CITY �T <br /> RIPON COUNTY ZIP <br /> SAN JOAQUIN 95366 <br /> MAILING ADDRESS <br /> 142 SOUTH STOCKTON CITY <br /> RIPON STATE ZIP <br /> PHONE W/APEA CODE CA 95366 <br /> 209-599-4209 TYPE OF BUSINESS <br /> (X) 01 GASOLINE STATION ( ) 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY <br /> 2 TOWNSHIP RANGE <br /> ------ <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 /> RIPON FIRE DEPT. 209-599-4209 <br /> RIPON FIRE DEPT. 209-599-4209 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X1 01 TANK ( ) 04 OTHER: <br /> CONTAINER NUMBER XL <br /> B. MANUFACTURER (IF APPROPRIATE): MODESTO TANK <br /> YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 350 GALLONS ( I UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) O1 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED (X) 02 REGULAR f ) 03 PREMIUM f 1 04 DIESEL ( ) 05 WASTE OIL ( ) O6 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 12 (X) GAUGE ( ) INCHES ( ) CM ( ) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED IX) 02 SINGLE WALLED ( ) 03 LINED <br /> D. ( .l 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 1 07 STEEL CLAD ( ) 08 BRONZE f ) 09 COMPOSITE ( 1 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> SC04-070185 (10/18/85) <br /> PAGE 1 <br /> a <br />