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4,4, Avg - - , <br /> STATE ID NUMBER <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( 1 01 NEW PERMIT [ 1 05 RENEWED PERMIT (dlr 07 TANK CLOSED Qk4- 09 DELETE FROM FILE (NO FEE1 <br /> { ) 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT [ ) 08 MINOR CHANGE (NO SURCHARGE) �� <br /> I OWNER <br /> NAME(COPPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> LODI IRON WORKS. INC. [ ) 01 FED ( 1 02 STATE [ 1 03 LOCAL <br /> STREET ADDRESS CITY STATE rz, <br /> R <br /> 1029 S. SCHOOL STREET LODI CA 240 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> LODI IRON WORKS. INC. <br /> STREET ADDRESS ��f� NEAREST CROSS STREET <br /> SCZQ �. �t�C�`Gc/Yl /R fQ PARK <br /> CIT'r <br /> COUNTY YIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESS CITY STATE ZIP <br /> P.O. BOX 71 LODI CA 95240 <br /> PHONE WtAREA CODE =71PESINESS <br /> 209-368-5395 SOLINE STATION (X) 02 OTHER. FOUNDRY <br /> NUMBER CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> III 24 'HOUR EMERGENCY CONTACT PERSON <br /> DA`I'S: NAME(L.AST NAME FIRST) AND PHONE WJAREA CODE FNZGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> VAN STEENBERGE, KEVIN 209-368-5395 STEENBERGE, KEVIN 209-368-7240 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( l 04 OTHER: <br /> CONTAINER NUMBER #2 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG. C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 500 GALLONS ( l UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES); <br /> (X) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( 1 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 12 [X) GAUGE ( 1 INCHES € 1 CM ( ) UNKNOWN <br /> B. ( l 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( 1 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL [ ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> f ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) <br /> PAGE I <br />