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• • STATE ID NUMBER 00000010517002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED <br /> ( ) 09 DELETE FROM FILE (NO FEE) <br /> 02 CONDITIONAL PERMIT l ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I <br /> OWNER <br /> PUBLIC AGENCY ONLY <br /> NAME(CCPPORATION.INDIVIDUAL OR PUBLIC AGENCY) ( ) 01 FED ( 7 02 STATE I ) 03 LOCAL <br /> RO-TILE INC. <br /> CITY STATE <br /> __F_ <br /> IP <br /> STREET ADDRESS LODI CA 95241 <br /> ,%RS S. STOCKTON STREET <br /> FACILITY <br /> DEALER/FOREMAN/SUPERVISOR <br /> FACILITY NAME <br /> RO-TILE INC. <br /> NEAREST CROSS STREET <br /> STREET ADDRESS HWY 12 <br /> 1625 S. STOCKTON STREET <br /> COUNTY ZIP <br /> CITY SAN JOAQUIN 95240 <br /> LODI <br /> CITY STATE ZIP <br /> MAILING ADDRESS LOO) CA 95241 <br /> P.O. BOX5W.7 y-I <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-334-1380 ( ) 01 GASOLINE STATION (X) 02 OTHER TILE MANUFACTURER <br /> NVMBE4 OF CONT AINE.eS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> . <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) <br /> AN4-3429PHONE <br /> W/AREA CODE <br /> BER K D. THOMPSON 209-334-1380 BERK D. THOMPSON <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( 7 04 OTHER: CONTAINER NUMBER 2 <br /> B. MANUFACTURER (IF APPROPRIATE): PERKINS YEAR MFG: C. YEAR INSTALLED 1981 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( 1 O1 WASTE (X) 02 PRODUCT <br /> F. DOES THE <br /> CONTAINER STORE <br /> ERMOTOR VEHICLE FUEL ORMDIESEL 05 WASTE OIL0( 7E (X)WAS020Io (I) YES <br /> S06 OCHECK APPROPRIATE SOX(ES): <br /> O <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 10 (X) GAUGE ( ) INCHES ( 1 CM ( 7 UNKNOWN <br /> B. ( 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) O1 DOUBLE WALLED (X) 02 SINGLE WALLED ( l 03 LINED <br /> D. (X) 01 CARBON STEEL ( 7 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE l ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 1 07 STEEL CLAD l ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( 1 12 UNKNOWN Y 1 13 OTHER: <br /> PAGE 1 <br /> HSC04-070185 (10/18/85) <br />