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STATE ID NUMBER 00000037645002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( 102 CONDITIONAL PERMIT ( > 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORFORATION,INDIVIOUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> ROSE LEE PRATER ( ) 01 FED f ) 02 STATE ( ) 03 LOCAL <br /> STPEET ADD-ESS CITY STATE ZIP <br /> 15594 S SEXTON ESCALON CA 95320 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> ROSE LEE PROLER ROSE LEE PROLER <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 15594 S. SEXTON LONE TREE RD <br /> CITY COUNTY Zip <br /> ESCALON .SAN JOAQUIN 95320 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 15594 S. SEXTON ESCALON CA 95320 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-838-3169 ( ) 01 GASOLINE STATION f ) 02 OTHER <br /> NUMBER. OF CONTAZNE P.S RURAL AREAS ONLY TOWNSHIP RANGE 'SECTION <br /> 3 1S 9E 30 <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 /> PRATER ROSE LEE 209-838-3169 PRATER, ROSE LEE 209-838-3169 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 2 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> 0. CONTAINER CAPACITY: GALLONS (X) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE ( ) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES (X) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> f l 01 UNLEADED f ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( l 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> D <br /> A. THICKNESS OF PRIMARY CONTAINMENT: l ) GAUGE l ) INCHES ( Y CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( 1 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( 103 LINED <br /> 0. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> ( ) 06 ALUMINUM [ l 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE f ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN t ) 13 OTHER: <br /> HSC04-070185 (10/18/857 PAGE 1 <br />