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0 <br /> i <br /> STATE ID NUMBER <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( 1 01 NEW PERMIT <br /> ( ) 05 RENEWED PERMIT ( ) 07 TAN!( CLOSED 1 ) 09 DELETE FROM FILE (NQ FEE) <br /> t 1 02 CONOITIONAL PERMIT { ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGr CY) PUBLIC AGENCY ONLY <br /> Llttio„ Coil f omr any 92C 6aliforn(a dlxe L1 F .I©�L <br /> � ( 1 01 FED ( 1 02 STATE ( ) 03 LOCAL <br /> $TWEET ADDRESS <br /> 2175 N. Lali+Fornia 1311, , SL,titct tasty clTr <br /> ___-- Walhvt Graek $TATA "I'4'S9Gi <br /> II FACILITY <br /> fACILtTY NAME DEALER/FOREMEN/SUPERVISOP <br /> STREET FOCPESS NEAREST CROSS STREET <br /> CITY <br /> COUNTY ZIP <br /> MAILING ADDRESS CITY STATE ZIP <br /> PHONE W/AFE; CODE =TYIESINESS <br /> ASOLINE STATION 1 ) 02 OTHER <br /> NUMBER OF CONTAINEPS PUPAL AREAS ONLY : TOWNSHIP RANGE SECTION <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 /> HG Far lavkC z R. L . *5) 945 -7Ca7Co <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. ( 1 01 TA1IK ( 1 02 OTHER: CONTAINERNUMBER <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR IN <br /> ( 1 UNKNOWN <br /> D. CONTAINER CAPACITY: GALLONS ( ) UNKNOWN JE. DOES THE CONTAINER STORE. t 1 01 WASTE ( ) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES c 1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> 1 ) <br /> 01 UNLEADED ( ) 02 REGULAR t ) 03 PREMIUM ( 1 04 DIESEL ( 1 05 WASTE OIL ( ! 05 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( 1 INCHES l f CM 1 I UNKNOWN <br /> 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) 1 ) 02 NON—VAULTED 1 1 03 (1NKNOIJII <br /> C. ( I 01 .00USLE WALLED ( ) 02 SINGLE WALLED ( 1 03 LINEO <br /> D. ( 1 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> 1 1 06 ALUMINUM ( ) 07 STEEL CLAD [ 1 06 BRONZE 1 1 09 COMPOSITE ( 1 10 NON—METALLIC <br /> ( 1 12 Ut4KNOWN { ) 13 OTHER. <br /> ISC04-070185 <br /> PAGE 1 <br />