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STATE ID NUMBER 00000044620003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAb . TANK <br /> (�{Itll NEW PERMIT ( l 05 RENEWED PERMIT ('507 TANK CLOSED Lk. 09 DELETE FROM FILE (NO FEEL <br /> /r' ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT t ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COP,PORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> VALLEY INDUSTRIES, INC. ( ) 01 FED ( ) 02 STATE ( l 03 LOCAL <br /> STREET ADDRESS [LDDI <br /> Y STATE ZIP <br /> 1313 S. STOCKTON ST. CA 95240 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> VALLEY INDUSTRIES, INC. FRED BAUMBACH <br /> STREET ADDRESS , / NEAREST CROSS STREET <br /> FAV "i6( HWY. 12 <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESS CITY STATE ZIP <br /> P.O. BOX 850 LODY CA 95241 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-368-8881 ( 1 01 GASOLINE STATION (X) 02 OTHER MFG. PLANT <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 3 <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/.4PEA CCDE <br /> BAUMBACH, FRED 209-368-8881 BAUMBACH, FRED 209-334-2425 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. •(X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER T-2 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: FCYEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 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 /> (X) 01 UNLEADED ( l 02 REGULAR ( l 03 PREMIUM ( l 04 DIESEL ( l 05 WASTE OIL ( ) 06 OTHER, <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ) 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( l 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />