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r �/N\_� STATE IO NUMBER 00000040426001 <br /> APPLICAT R PERMIT TO "OPERATE UNDERGROUND STORAGE TANK <br /> ( 1 <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT y 07 TANK CLOSED yi�y9 DELETE FROM FILE (NO FEE) <br /> ( 1 02 CONDITIONAL PERMIT f 1 06 AMENDED PERMIT "CSS 08 MINOR CHANGE (NO SURCHARG'*`P <br /> I OWNER <br /> NAME(COPPOPATION,INDIVIOUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> RANOOLPH D. SAVIG f ) 01 FED l ] 02 STATE ( ) 03 LOCAL <br /> STREET .ADDRESS CITY STATE ZIP <br /> 15922 N. TRETHEWAY RD LODI CA 95240 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> RANDOLPH D. SAVIG <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 15922 N. TRETHEWAY RD KETTLEMAN LANE <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN 95240 <br /> CITY STATE ZIP <br /> 15922N ADDRESS <br /> 15922 N. TRETHEWAY RD LODI CA <br /> PHONE W/AREACODE TYPE OF BUSINESS <br /> 209-368-4627,( ( 1 01 GASOLINE STATION (X) 02 OTHER HOME <br /> NUMBER OF CONTAINERS PUPAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> 1 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: 4AME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> BALTZER WALTER 209-368-5410 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 01 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 300 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) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM f 1 04 DIESEL f 1 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( 1 GAUGE f Y INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) O1 DOUBLE WALLED ( ] 02 SINGLE WALLED ( 1 03 LINED <br /> O. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL f ) 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( 1 09 COMPOSITE ( 1 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> PAGE 1 <br /> HSC04-070185 (10/18/85) <br />