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STATE ID NUMBER 00000048078002 <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 /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARG <br /> I OWNER <br /> NAME(COPPOP.ATIONIINDIVIOUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> WESTERN FARM SERVICE, INC. ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 35100 S. HWY 33 71VERNALIS CA 95385 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> WESTERN FARM SERVICE. INC. JIM TAYLOR <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 35100 W. HWY 33 WELTY ROAD <br /> CITY COUNTY ZIP <br /> VERNALIS SAN JOAQUIN 95385 <br /> MAILING ADDRESS CITY STATE ZIP <br /> P.O. BOX 766 VERNALIS CA 95385 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-835-7597 ( ) 01 GASOLINE STATION (X) 02 OTHER AG CHEM <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 2 3S 6E 27 <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 /> TAYLOR, JIM 209-477-3187 TAYLOR, JIM 209-477-3187 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. f ) 01 TANK (X) 04 OTHER: SUMP CONTAINER NUMBER 1981W <br /> B. MANUFACTURER (IF APPROPRIATE): ANDERSON CO. YEAR MFG: 1981 C. YEAR INSTALLED 1981 ( 1 UNKNOWN <br /> D. CONTAINER CAPACITY: 350 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: (X) 01 WASTE f ) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES (X) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( 7 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL f ) 05 WASTE OIL ( l 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 6 f ) GAUGE (X) INCHES ( ) CM ( ) UNKNOWN <br /> B. ( 7 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. (X) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( ) 03 LINED <br /> D. ( ) 01 CARBON STEEL ( 7 02 STAINLESS STEEL ( 1 03 FIBERGLASS t ) 04 POLYVINYL CHLORIDE (X) 05 CONCRETE <br /> ( ) 06 ALUMINUM f ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( l 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />