Laserfiche WebLink
o" 0 0 STATE ID NUMBER <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK _- <br /> ( ) 04 DELETE FROM FILE (N0 FEE) I <br /> 01, iNEW PERMIT l 1 05 RENEWED PERMIT 1 107 TANK CLOSED - <br /> 1 02 CONDITIONAL PERMIT t 1 06 AMENDED PERMIT t 9 08 MINOR CHANGE IND SURCHARGE) <br /> I OWNER --- <br /> 1 - -- -- - PUBLIC AGENCY ONLY <br /> $"Am!,CCAa4PATION,iNCIVIOUAL OR PUBLIC AGENCYQ)� I 1 01 FED I 1 02 STATE t .1 03 LOCAL <br /> ---- <br /> - STATE TiIP <br /> !STREET ?C^FESS CITY <br /> kfII FACILITY <br /> IFACILT_TT 4AME - — DEALER/FC�M <br /> tc <br /> STREET ACD'ESS NEAPES7 CROSS STPEE <br /> CITY 7� /J O COUNTY ZIP <br /> MAILIN JD PESO — Fc, <br /> TY `y/,� S Z� <br /> RHOP ,ArETrPE OF BUSINESS — — _ <br /> L r ( 1 O1 GASOLINE STATION02 OTHER <br /> ') <br /> jNUY AINERS _��" PUPAL AREAS ONLY TnWNSHIP RANGE SECTION <br /> III 2(1 HOUR EMERGENCY CONTACT PERSON <br /> FIRST) iAPEA CEDE <br /> }DAYS: NAN,EILAST NAME FIPST) AND PHONC W/APEA CODE NIGHTS:: NNAMEIIAST NAME ��yAND PN NE <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DE SCR IPTION — ----- - <br /> A. f7e�, 01 TANK f 1 02 OTHER CONTAINER NUMBER <br /> B. hIANUfACTURER tIF APPRONRIATEI; YEAR MFG C. YEAR INSTALLED---- iJ� UNKNOWN <br /> D. CONTAINER CAPACITY: L!�U GALLONS UNKNOW�EOOES THE CONTAINER STORE: 1 I 01 HASTE 02 PRODUCT --F. DOES THE CONTAIIIER STORE MOTOR VEHICLE FUEL OR WASTE OIL 'r,_P:61 01 YES l 1 02 NO IF YES CHECK APPROPRIATE BOX(ESI' <br /> f 1 01 UNLEADED F 102 REGULAR 1 1 03 PREMIUM K 04 DIESEL ( ) 05 WASTE OIL [ 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> �A. THICY,NESS OF PRIMARY CONTAINMENT: t 1 GAUGE f I INCHES 1 l CM K UNKNOWN <br /> iB. f V 01 VAULTED (LOCATED-IN AN U110ERGROUND VAULT) ( 1-02 NON-VAULTED 03 UNKNOWN <br /> C. [ I Ol DOUBLE WILLEO 1 ) 02 SINGLE WALLED f 1 03 LIMED - --- -_i--_-- -- <br /> r <br /> }0. 1 1 O1 CARBON STEEL ( 1 02 STAINLESS STEEL f 1 03 FIE <br /> ERGLAS5 ( 1 04 POLYVINYL CHLORIDE ( 105 CONCRETE <br /> }} f 1 06 ALUMINUM ( 1 07 STEEL CLAD ( 1 08 BRDIIZE I ) 09 COMPOSITE ( I 10 HON-METALLIC <br /> l 1 13 OTHER: —.-----.___— <br /> 77 - -- - <br /> _ - - - - -- -- — PAGE 1 <br />