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• - • STATE ID NUMBER 00000021465002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( 7 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> L OWNER <br /> NAME(CCRPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> SIMPSON PAPER COMPANY f ) 01 FED ( ) 02 STATE ( 7 03 LOCAL <br /> STREET AGGRESS CITY STATE ZIP <br /> 1 POST STREET SAN FRANCISCO CA 94104 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> SIMPSON PAPER COMPANY J.I. EISENMAN <br /> STREET ADDRESS NEAREST CROSS STREET <br /> SOUTH STOCKTON STREET IST AVENUE <br /> CITY COUNTY ZIP <br /> RIPON SAN JOAQUIN 95366 <br /> MAILING ADDRESS <br /> CITY STATE ZIP <br /> BOX 757 RIPON CA 95366 <br /> PHONE W/AP.EA CODE TYPE OF 6USINESS <br /> 209-599-4241 ( l 01 GASOLINE STATION (X) 02 OTHER PAPER MFG. <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> 2 <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 /> ABRAHAMSON, DENNIS 209-599-4241 ABRAHAMSON, DENNIS 209-529-3267 <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 MF�1962C. YEAR INSTALLED 1962 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 300 GALLONS [ 1 UNKNOWN E. DOES THE CONTAINER STORE: ( 1 O1 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES t 1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> f ) 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( 1 05 WASTE OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( 1 GAUGE f ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( l 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. fX) 01 CARBON STEEL f ) 02 STAINLESS STEEL f ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 7 07 STEEL CLAD ( 1 08 BRONZE f ] 09 COMPOSITE ( 1 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> PAGE I <br /> HSC04-070185 (10/18/85) <br />