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1..� Iftw0 STATE ID NUMBER 00000009595001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE` D <br /> ( ) 05 RENEWED PERMIT 07 TANK CLOSED DELETE FROM FILE (NO FEET <br /> ( ) O1 NEW PERMIT <br /> (/� <br /> ( ) 02 CONDITIONAL PERMIT 1 ] 06 AMENDED PER <br /> ( 1 08 MINOR CHANGE (NO SURCHARGE <br /> I OWNER <br /> PUBLIC AGENCY ONLY <br /> NAME(COPPORATION,INDIVIDUAL OR PUBLIC AGENCY) ( ) O1 FED ( ) 02 STATE ( 1 03 LOCAL <br /> SAN JOAQUIN SULPHUR CO.. INC <br /> CITY STATE ZIP <br /> STREET ADDRESSLODI CA 95240 <br /> 720 N. SACRAMENTO ST. <br /> II FACILITY <br /> DEALER/FOREMAN/SUPERVISOR <br /> FACILITY NAME PAT BROWN <br /> SAN JOAQUIN SULPHUR CO.. INC. <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 720 N. SACRAMENTO ST. LOUIE <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING AOOPESS <br /> CITY STATE ZIP <br /> P.O. BOX 700 LODI CA 95241 <br /> F <br /> W/AREA CODE TYPE OF BUSINESS68-6676 ( l O1 GASOLINE STATION (X) 02 OTHER RETAIL AG CHEM. <br /> P 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/APEA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> BROWN, PAT 209-368-6676 BROWN, PAT 209-369-3868 <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: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 500 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: [ ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (XI 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( 1 05 WASTE OIL f 1 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. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED f 103 LINED <br /> 0. (X) 01 CARBON STEEL ( 1 02 STAINLESS STEEL f 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( 1 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON—METALLIC <br /> f ) 12 UNKNOWN ( 3 13 OTHER: <br /> KSC04-070185 (10/18/85) PAGE 1 <br /> %a/ <br /> STATE ID NUMBER 00000009595001 <br /> CONTAINER CONSTRUCTION <br /> E. ( ) 01 RUBBER LINED ( ) 02 ALKYD LINING ( ) 03 EPDXY LINING ( 1 04 PHENOLIC LINING ( 1 05 GLASS LINING <br /> ( ) 07 UNLINED (X) OB UNKNOWN ( ) 09 OTHER: <br /> F. ( ) 01 POLYETHLENE WRAP f 7 02 VINYL WRAPPING f 1 03 CATHODIC PROTECTION (X) 04 UNKNOWN f ) 05 NONE <br /> ( ) 06 TAR OR ASPHALT ( ) 09 OTHER: <br /> VI PIPING <br /> A. ABOVEGROUND PIPING: ( ) 01 DOUBLE—WALLED PIPE ( ] 02 CONCRETE—LINED TRENCH ( l 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) ( 1 04 PRESSURE ( ) 05 SUCTION (X) 06 UNKNOWN ( ) 07 NONE <br /> B. UNDERGROUND PIPING: ( ) 01 DOUBLE—WALLED PIPE ( ) 02 CONCRETE—LINED TRENCH (X) 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE (X) 05 SUCTION l ) 06 UNKNOWN ( ) 07 NONE <br /> VII LEAK DETECTION <br /> f ) <br /> 01 VISUAL ( ) 02 STOCK INVENTORY f 1 04 VAPOR SNIFF WELLS f , 05 SENSOR INSTRUMENT <br /> f ) 06 GROUND WATER MONITORING WELLS ( 1 07 PRESSURE TEST (X) 09 NONE ( ) 10 OTHER: <br /> VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS <br /> IF YOU CHECKED YES TO IV-F YOU APE NOT REQUIRED TO COMPLETE THIS SECTION <br /> CUPPENTLY PREVIOUSLY DELETE CASH (IF KNOWN) CHEMICAL (DO NOT USE COMMERCIAL NAME) <br /> STORED STORED <br /> ( ) 01 ( ) 02 ( 1 03 <br /> ( , 01 () 02 ( ) 031111111111111 <br /> f 1 01 ( ) 02 ( ) 03 <br /> ( ) <br /> 01 ( ) 02 ( ) 03 <br /> ( I O1 ( ) 02 ( 1 03 <br /> f 1 O1 ( ) 02 ( ) 03 <br /> ( l 01 f ) 02 ( 1 03 <br /> ( l <br /> 01 ( ) 02 ( 1 03 <br />