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./IJ ( • STATE ID NUMBER 00000037605001 <br /> APPLICATION FOR PERMIT T / (1N G OUND STORAGE TANK <br /> PERMIT ( ) 05 RENEWED PERMIT 6„j' QS, ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( 7 02 CONDITIONAL PERMIT f ) 06 AMENDED PERMITG! O SURCHARGE) <br /> I OWNER <br /> NAMECCORPCRATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> ESCALON UNIFIED SCHOOL DISTRICT ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 1520 YOSEMITE AVENUE ESCALON CA 95320 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> VAN ALLEN SCHOOL RUSSELL DRTLOFF <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 21051 EAST HIGHWAY 120 VAN ALLEN ROAD <br /> CITY COUNTY ZIP <br /> ESCALON. SAN JOAQUIN 95320 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 1520 YOSEMITE AVENUE ESCALON CA .95320 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-838-3165 ( ) 01 GASOLINE STATION (X) 02 OTHER PUBLIC SCHOOL <br /> NUMBER OF_CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <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 /> ORTLOFF, RUSSELL 209-838-3165 ORTLOFF, RUSSELL 2.09-838-7181 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 5 <br /> B. MANUFACTURER (IF APPROPRIATE): LINK YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 500 GALLONS f l UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES f 1 02 NO IF YES CHECK APPROPRIATE BOX(ES); <br /> ( ) 01 UNLEADED ( 1 02 REGULAR It ) 03 PREMIUM (X) 04 DIESEL ( l 05 WASTE OIL f l 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE i I INCHES It ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED. ( ) 03 UNKNOWN <br /> C. f ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED f 7 03 LINED <br /> D. (X) 01 CARBON STEEL f ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( 1 09 COMPOSITE ( ] 10 NON-METALLIC <br /> It ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> 40 41 <br />