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STATE ID NUMBER 00000032494003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( 1 11 NEW PERMIT ( ) 0 <br /> 5 RENEWED PERMIT ( 1 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CCRPCPATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> EDWIN PEREIRA ( ) O1 FED ( ) 02 STATE t ) 03 LOCAL <br /> STREET ADDRESS TESCALON <br /> STATE ZIP <br /> 20413 E. HWY 120 CA 95320 <br /> II FACILITY <br /> FACILITY N4`!E DEALER/FOREMAN/SUPERVISOR <br /> EDWIN PEREIRA NONE <br /> STREET ADDPESS NEAREST CROSS STREET <br /> 20413 E. HWY 120 VAN ALLEN <br /> CITY COUNTY ZIP <br /> ESCALON SAN JOAQUIN 95320 <br /> MAILING ADDPESS CITY STATE ZIP <br /> 20413 E. HWY 120 SAME CA 95320 <br /> PHONE W/A.P.E.A CODE T1PE OF BUSINESS <br /> 209-838-7898 ( ) 01 GASOLINE STATION (X) 02 OTHER FARM <br /> NUMBER OF CONTAINERS PUPAL APEAS ONLY TOWNSHIP RANGE SECTION <br /> 3 T1S R8E 35 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> k��A, <br /> NAME(LAST NAME FIRST) AND PHONE W/APEA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/ARE.A CODE <br /> EDWIN 209-833-7898 SAME - - <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: 1978 C. YEAR INSTALLED 1978 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 550 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: t ) 01 WASTE (X) 02 PRODUCT <br /> f. DOES THE CONTAINER STORE OR VEHICLE FUEL OR WASTE OIL ? ( ) O1 YES (X) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) O1 UNLEADED (X) 02 REGULAR ( 1 03 PREMIUM ( ) 04 DIESEL ( ) OS WASTE OIL ( l 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 12 (X) GAUGE ( ) INCHES ( l CM f 1 UNKNOWN <br /> B. ( 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> O1 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( 1 09 COMPOSITE ( ) 10 NON-METALLIC <br /> t ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />