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STATE ID NUMBER 00000001198001 <br /> APPLICATION FOR PERMIT TO OPER TE UNDERGROUND STORAGE TANK <br /> (XL 01 NEW PERMIT ( 1 05 RENEWED PERMIT ) 0 TANK CLOSED <br /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) ( ) 09 DELETE FROM FILE (NO FEE) <br /> (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPORATION,INDIVIDUAL OR PUBLIC AGENCY) <br /> J I CASE COMPANY PUBLIC AGENCY ONLY <br /> ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS <br /> 700 STATE STREET CITY STATE ZIP <br /> RACINE WI <br /> 53404 <br /> II FACILITY <br /> FACILITY NAME <br /> CASE POWER & EQUIPMENT DEALER/FOREMAN/SUPERVISOR <br /> LOUIS LEWEY <br /> STREET ADDRESS <br /> 30131 CONNECTOR ROAD NEAREST CROSS STREET <br /> CITY <br /> TRACY COUNTY <br /> SAN JOAQUIN ZIP <br /> MAILIN3 ADDRESS 95376 <br /> 30131 CONNECTOR ROAD CITY STATE ZIP <br /> TRACY CA 95376 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> voo-&TO-'NO ( ) 01 GASOLINE STATION (X) 02 OTHER EQUIPMENT DEALER <br /> NUMBER OF CONTAINERS RAL AREAS ONLY : TOWNSHIP <br /> I RANGE ------ <br /> 1 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND <br /> 209-Yf8 6vZ0' Gf(�(L PHONE W/AREA CODE2=0UY8�lfiiB7 <br /> �D209-�?e-6aee c?y s� <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> FA. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 1 <br /> UFACTURER (IF APPROPRIATE): <br /> YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: GALLONS (*I UNKNOWN E. DOES THE CONTAINER STORE: (X) 01 WASTE ( ) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( 1 03 PREMIUM ( ) 04 DIESEL (X) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> F <br /> KNESS OF PRIMARY CONTAINMENT: ( 1 GAUGE f ) INCHES f ) CM (X) UNKNOWNO1 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( 1 03 UNKNOWNO1 DOUBLE WALLED ( ) 02 SINGLE WALLED ( ) 03 LINED01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> 2 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) <br /> PAGE 1 <br />