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""� "':"� � `' • STATE ID NUMBER 00000036 25 9AFt' , <br /> LIGATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> l ) <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED <br /> 7`��' <br /> 4 1 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) 09 DELETE FROM FILE (HO FEE) <br /> I OWNER <br /> NAMC(OORPORATION,INOIVIDUAL OR PUBLIC AGlNCY) �/^O02.[ <br /> RZJ GOND ERO C PUBLIC AGENCY ONLY <br /> ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS <br /> 16401 E HWY 26 CITY STATE ZIP <br /> LINDEN CA 95236 <br /> II FACILITY <br /> '<CILITY NAME <br /> MID COUNTY FARM SERVICE DEALER/FOREMAN/SUPERVISOR <br /> AL SCHAEDE JR <br /> )STREET ADDRESS <br /> 16401 E HWY 26 NEAREST CROSS STREET <br /> MURRAY <br /> CITY <br /> COUNTY <br /> LINDEN ZIP <br /> SAN JOAQUIN 95236 <br /> &.AILING ADDRESS <br /> P.O. BOX 659 CITY STATE ZIP <br /> LINDEN CA 95236 <br /> f PHONE W/APEA ^CODE TYPE OF BUSINESS <br /> 209-931-OW 4?/Jt'Tt ( ) O1 GASOLINE STATION (X) 02 OTHER AG CHEM DEALER <br /> NUM!!& OF CONTAINERS RURAL AREAS ONLY : TOWNSN IP RANGE <br /> 2 SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> O AYS: NAME(IAST NAPE FIRST) AND PHONE W/AREA CODE NIGHTS: NAMEf LAST NAME FIRST) AND PHONE W/AREA CODE <br /> iSCHAEDE AL 209-887-3214 SAME <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( 1 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 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) O1 YES ( l 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) O1 UNLEADED ( ) 02 REGULAR f ) 03 PREMIUM (X) 04 DIESEL ( 1 05 WASTE OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( 1 GAUGE l ) INCHES f ) CM (X) UNKNOWN <br /> B. f ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( ) 03 LINED <br /> D. ( 1 01 CARBON-STEEL ( ) 02 STAINLESS STEEL ( 103 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE l ) 05 CONCRETE <br /> ( ) 06 ALUMINUM (X) 07 STEEL CLAD ( 1 08 BRONZE ( ) 09 COMPOSITE ( 1 10 NON-METALLIC <br /> ( 1 12 UNKNOWN ( ) 13 OTHER: <br /> SC04-070185 (10/18/85) <br /> PAGE 1 <br />