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ti, STATE ID NUMBER 00000019241001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 1 NEW PERMIT ( ) 05 RENEWED PERMIT ( 1 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> _20,9 <br /> 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( 1 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAM!(CORPORATION�ZND IV ID UAI OR PVDLIC AGENCY) PUBLIC AGENCY ONLY <br /> N ( ) O1 FED ( 1 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS exry �G7Y/S STATE- <br /> ZIP <br /> �- �7soo� �rant'� <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> CELPRIL INDUSTRIES INC. <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 251 OAK ST. <br /> CITY COUNTY IF <br /> MANTECA SAN JOAQUIN 95336 <br /> MAIEOAK <br /> ADDRESS CITY STATE ZIP <br /> 251ST MANTECA CA 95336 <br /> PHOAREA CODE TYPE OF BUSINESS <br /> 2091145 ( ) O1 GASOLINE STATION (X) 02 OTHER SEED COATINGS <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 /> RONALD LEWIS 209-823-1145 1 244-4a+-6-354 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( 1 04 OTHER: CONTAINER NUMBER 1 <br /> S. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 350 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: l ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) Ol YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) <br /> 01 UNLEADED (X) 02 REGULAR ( 1 03 PREMIUM ( ) 04 DIESEL ( 1 05 WASTE OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( 1 INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. f I 01 DOUBLE WALLED ( 1 02 SINGLE WALLED ( ) 03 LINED <br /> D. {)O 01 CARBON STEEL ( 1 02 STAINLESS STEEL l l 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( l 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( 108 BRONZE ( 109 COMPOSITE ( ) 10 NON-METALLIC <br /> f00-32 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE I <br />