Laserfiche WebLink
• 0 STATE ID NUMBER 0000005011800 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( 1 <br /> 01 NEW PERMIT ( 1 05 RENEWED PERMIT (W 07 TANK CLOSED 0d 09 DELETE FROM FILE (NO FEE) <br /> f 1 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I <br /> I OWNER <br /> NAME(CORPORATION.iNOIVIDUAL OR PUBLIC AGENCY) <br /> DAGOBERT SCHMIDT PUBLIC AGENCY ONLY <br /> ( ) <br /> 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS <br /> 1220 E. PINE ST. cxiY STATE ZIP <br /> LODI CA 95240 <br /> II FACILITY <br /> FACILITY NAME <br /> PRIMA-CAST & MFG. INC. DEALER/FOREMAN/SUPERVISOR <br /> STREET ADDRESS <br /> 1220 E. PINE ST. NEAREST CROSS STREET <br /> CLUFF ST. <br /> CITY <br /> COUNTY <br /> LODI ZIP <br /> SAN JOAQUIN 95240 <br /> MAILING ADDRESS <br /> 1220 E. PINE ST. CITY STATE ZIP <br /> SAME CA 95240 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-369-7044 ( ) 01 GASOLINE STATION (X) 02 OTHER MANUFACTURER OF ALUM <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE <br /> 1 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 /> SCHMIDT 0. 209-369-7044 SCHMIDT, 0. 209-368-3118 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> PMANUFACTURER <br /> ANK ( ) 04 OTHER: CONTAINER NUMBER 1 <br /> (IF APPROPRIATE): ARCO YEAR MFG: 1980 C. YEAR INSTALLED 1980 ( 7 UNKNOWN <br /> R CAPACITY: 1000 GALLONS f ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) O1 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> NLEADED (X) 02 REGULAR ( 1 03 PREMIUM f ) 04 DIESEL ( ) 05 WASTE OIL ( 7 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> FTHICKNESS OF PRIMARY CONTAINMENT: 10 (X) GAUGE ( I INCHES ( 1 CM ( ) UNKNOWN <br /> 1 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> 1 DOUBLE WALLED (X) 02 SINGLE WALLED ( 1 03 LINED <br /> 1 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE [ ) 05 CONCRETE <br /> 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> UNKNOWN ( ) 13 OTHER: <br /> ISC04-070185 (10/18/85) <br /> PAGE 1 <br />