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STATE ID NUMBER 00000049917001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> (SQ Ol NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( 7 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> ENAME(CORPCPATICIN,IENDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> FRANKEL ( ) O1 FED ( 7 02 STATE ( ) 03 LOCAL <br /> CITYSTATE ZIP <br /> ADDRESS CHICAGO IL 60654 <br /> RCHANDISE M <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SFIEPPr'm er <br /> U.S. POSTAL SERVICE VMF P.M. SCHOLZEN) +/� <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 4245 WEST LANE • <br /> COUNTY ZIP <br /> CITY SAN JOAQUIN 952.08- <br /> S <br /> 5208- <br /> STOCKTON <br /> CITY STATE_ ZIP <br /> MAILING ADDRESS , C,j _ I�.LO �• 95208 <br /> 4245 WEST LANE sAlmeJ�o <br /> PHONE W/ATEA CODE TYPE OF BUSINESS <br /> 209-946-6316 ( ) O1 GASOLINE STATION (X) 02 OTHER REPAIR FACILITY <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> GAYS:. NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS:NAMV LAST NAME FIRST) AND PHONE W/AREA CODE <br /> rr wl W -611 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( 7 04 OTHER: CONTAINER NUMBER 01 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1963 ( 7 UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS [ 7 UNKNOWN E. DOES THE CONTAINER STORE: l 1 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES f 7 02 NO IF YES CHECK APPROPRIATE SOX(ES): <br /> (X) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( l 05 WASTE OIL ( 7 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( 1 GAUGE ( 1 INCHES ( ) CM (X) UNKNOWN <br /> B. f ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. t ) 01 DOUBLE WALLED ( l 02 SINGLE WALLED [ ) 03 LINED <br /> 0. f ) 01 CARBON STEEL ( 1 02 STAINLESS STEEL f ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> f ) 06 ALUMINUM ( ) 07 STEEL CLAD ( 7 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( 7 13 OTHER: <br /> PAGE 1 <br /> HSC04-070185 (10/18/85) <br />