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STATE IO NU?tBER 00000012531003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> [ ) 01 NEW PERMIT [ } 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEET <br /> t ) 02 CONDITIONAL PERMIT f ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPOPA.TICN,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> FRANK SUNSERI 8 RONALD DANIEL [ ) 01 FED i ) 02 STATE f ) 03 LOCAL <br /> STREET ADOP.ESSGITY STATE IIP <br /> 1210 TURNER RD LODI CA 95240 <br /> II FACILITY <br /> FACILITY NAME DEALER/FCREMAN/SUPERVISOR <br /> EOWLES SERVICE MIKE BOWLES <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1216 TURNER RD LOMA <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 1210 TURNER RD LODI CA 95240 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-369-5314 ( ) 01 GASOLINE STATION (X) 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGC SECTION <br /> 4 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIPST) AND PHONE W/APER CODE NIGHTS: N:AME(L.A.ST NAME FIRST) AND PHONE W/AREA CODE <br /> SUNSERI, FRANK 209-369-5314 SUNSERI, FRANK 209-369-5314 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK [ ) 04 OTHER: CONTAINER NUMBER 3 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 4000 GALLONS [ ) UNKNOWN E. DOES THE CONTAINER STORE: f ) 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 BOXIEST: <br /> ( ) 01 UNLEADED ( ) 02 REGULAR (X) 03 PREMIUM [ l 04 DIESEL ( l 05 WASTE OIL [ ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> 4 <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 3/16 ( T GAUGE (XI INCHES ( ) CM ( ) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( 7 03 UNKNOWN <br /> C. ( l 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( l 03 LINED <br /> D. (X) 01 CARBON STEEL [ ) 02 STAINLESS STEEL f } 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> f ) 06 ALUMINUM ( ) 07 STEEL CLAD f ) 08 BRONZE ( l 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/851 PAGE 1 <br />