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s • And STATE ID NUMBER 00000047929001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 1 1 01 NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE IND FEE]) <br /> 1 1 02 CONDITIONAL PERMIT ( 1 06 AMENCED PERMIT ( 1 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NA.-,E(COCPCRAT:ON,:Nn:V:DUAL op PU9 L(:C AcENcn PUBLIC AGENCY ONLY <br /> R 1 ( 1 01 FED f ) 02 STATE I ) 03 LOCAL <br /> STREET ACOPESS CITY STATE 2:P <br /> 15634 SOUTH STEINEGUL ROAD ESCALON CA 95320 <br /> II FACILITY <br /> IF-CILITY NAME CEALEP/FOPEMAN;SUPEPVISOQ <br /> C(n RAYMOND YMO�E_E_R <br /> '.EET AODPESS NEAREST CROSS STREET <br /> 15634 SOUTH STEINEGUL ROAD LONE TREE ROAD <br /> C-TY <br /> COUNTY ZIP <br /> ESCALON SAN JOAQUIN <br />_ 95320 <br /> Y.Aa:NO ADDRESS CITU <br /> 4CA <br /> ATE ZIP <br /> 15634 SOUTH STEINEGUL ROAD <br /> ESC <br /> 95320 <br /> FMONE W.'APEA CODE T)PE OF BUSINESS <br /> i9!'-dS8'3=F63— ( ) 01 GASOLINE STATION (X) 02 OTHER RESIDENTIAL STORAGE <br /> NJ`:BEP OF CONTA:NEPS PUPAL AREAS CNIYTOwNSH2P p4NGE SECTION <br /> -I— <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NA`<E(LOST NAME FIPSTI AND PHONE W/AVER CODE NIGHTS: NAMEf LAST NAME FIPSTI AND PHONE W,'AREA CODE <br /> PHTCLrF9T-OENi5£ 2II9-465-721¢ GR4ER oAYMOI.n __zDy_gjg_T-,FT- <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />[V DESCRIPTION <br /> A. fXl 01 TANK f 1 04 OTHER: CONTAINER NUMBER 1 <br /> 3. MANUFACTURER (IF APPROPRIATE): MODESTO WELDING YEAR MFG: C. YEAR INSTALLED 1980 ( 1 UNKNOWN <br /> D. CONTAINER CAPACITY: 550 GALLONS f I UNKNOWN E. DOES THE CONTAINER STORE: I 1 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( 1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> f 1 <br /> 01 UNLEADED (X) 02 REGULAR ( 103 PREMIUM 1 1 04 DIESEL f 1 05 WASTE OIL I l 06 OTHER <br /> f CONTAINER CONSTRUCTION <br /> I <br /> 4. THICKNESS OF PRIMARY CONTAINMENT: f l GAUGE ( i INCHES I 1 CM fXl UNKNOWN <br /> 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> 01 DOUBLE WALLED ( 1 02 SINGLE WALLED l ) 03 LINED <br /> I. (X) 01 CARBON STEEL ( 1 02 STAINLESS STEEL ( 1 03 FIBERGLASS I 1 04 POLYVINYL CHLORIDE f 1 05 CONCRETE <br /> f ) 06 ALUMINUM ( ) 07 STEEL CLAD 1 ) 08 BRONZE ( 1 09 COMPOSITE ( 1 30 NON-METALLIC <br /> 1 1 12UNK.NOI;N l 1 13 OTHER: <br /> iC04-070185 (10/18/85) PAGE 1 <br /> i <br />