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r STATE ID NUMBER 00000037645001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( 1 01 NEW PERMIT ( 1 05 RENEWED PERMIT f ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> ROSE LEE PRATER ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STPEET AODPESS 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 ( ) 02 OTHER <br /> NUM3EP CF CONTAINERS RURAL AREAS ONLY TOWNSHIP PANGS SECTION <br /> 3 13 9E 30 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAM--c(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CCDE <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 1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 550 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: f ) 01 WASTE f ) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? f 1 01 YES (X) 02 NO IF YES CHECK APPROPRIATE BOX(ESI: <br /> ( 1 <br /> 01 UNLEADED [ l 02 REGULAR f ) 03 PREMIUM ( l 04 DIESEL { 1 05 WASTE OIL ( l 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 12 (X) GAUGE ( l INCHES ( ) CM f ) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL f 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 107 STEEL CLAD ( 1 08 BRONZE ( 7 09 COMPOSITE ( ) 10 NON-METALLIC <br /> [ ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />