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STATE ID NUMBER 00000018822001 <br /> r <br /> APPLICATION FOR PERMIT TO ::)5mSTORAGE TANK <br /> ( 1 <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( 1 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CCRPOPATION,INDIVIOUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> BLEWETT DAIRY-C H BLEWETT ( ) 01 FED ( ) 02 STATE f ) 03 LOCAL <br /> STREET ADORES$ CITY STATE ZIP <br /> 221 S. SACRAMENTO ST. LODI CA 95240 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> BLEWETT DAIRY-C H BLEWETT , <br /> STREET ACDRESS NEAREST CROSS STREET <br /> 221 S. SACRAMENTO ST. <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 221 S. SACRAMENTO ST. LODI CA 95240 <br /> PHONE W/AREA'CODE TYPE OF BUSINESS <br /> 209-369-3519 ( ) 01 GASOLINE STATION (X) 02 OTHER DAIRY <br /> NJMSER 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/ARE.A CODE <br /> BLEWETT, C.H. 209-369-3519 - - <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): YEAR MFG: 1955 C. YEAR INSTALLED 1955 f ) UNKNOWN <br /> D. CONTAINER CAPACITY: 500 GALLONS f 1 UNKNOWN E. DOES THE CONTAINER STORE: f 1 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES ( 7 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> f 1 <br /> 01..UNLEADED (X) 02 REGULAR ( 1 03 PREMIUM ( 1 04 DIESEL ( 105 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( 1 INCHES 1 ) CM (X1 UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (XI 02 NON-VAULTED 1 1 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( 1 02 SINGLE WALLED ( 1 03 LINED <br /> 0. (X) 01 CARBON STEEL 1 ) 02 STAINLESS STEEL 1 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM: ( ) 07 STEEL CLAD l 1 08 BRONZE t ) 09 COMPOSITE ( 1 10 NON-METALLIC <br /> ( 1 12 UNKNOWN ( 1 13 OTHER: <br /> NSC04-070185 (10/18/85) PAGE 1 <br />