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���� � • <br /> STATE ID NUMBER 00000064599002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 01 NEW PERMIT 05 RENEWED PERMIT ( ) 07 TANK( ) CLOSED ) 09 DELETE FROM FILE (ND FEE) <br /> 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> RIPON CONSOLIDATED FIRE DISTRI ( 1 <br /> 01 FED 02 STATE ( ] 03 LOCAL <br /> ( 1 <br /> CITY STATE ZIP <br /> STREET ADDRESS RIPON CA 95366 <br /> 142 SOUTH STOCKTON <br /> II FACILITY <br /> FACIL'TY NAME DEALER/FOREMAN/SUPERVISOR <br /> RIPON CONSOLIDATED FIRE DIST ED BYNUM <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 142 SOUTH STOCKTON WEST MAIN <br /> CITY COUNTY ZIP <br /> RIPON SAN JOAQUIN 95366 <br /> MAILING ADDRESS <br /> CITY STATE ZIP <br /> 142 SOUTH STOCKTON RIPON CA 95366 <br /> FPHONE /AREA CODE TYPE OF BUSINESS-4209 ( ) O1 GASOLINE STATION (X1 02 OTHER FIRE DEPTOF 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/APEA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> BYNUM ED 209-599-4209 BYNUM ED 209-599-3337 <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): MODESTO TANK YEAR MFG: C. YEAR INSTALLED 1964 (X1 UNKNOWN <br /> D. CONTAINER CAPACITY: 200 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) Ol YES ( ] 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR (X) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 14 (X) GAUGE ( ) INCHES ( ) CM ( ) UNKNOWN <br /> B. f 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED (X1 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE f 1 05 CONCRETE <br /> f ) 06 ALUMINUM ( ) 07 STEEL CLAD [ ) 08 BRONZE ( ) 09 COMPOSITE f ) 10 NON-METALLIC <br /> f l 12 UNKNOWN ( ) 13 OTHER <br /> HSC04-070185 (10/18/85) PAGE 1 <br />