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• STATE ID NUMBER 00000042980001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> [ 1 01 NEW PERMIT f ) 05 RENEWED PERMIT tid) 07 TANK CLOSED (�09 DELETE FROM FILE (NO FEE) <br /> ( ) 0.2 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION.:NDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> BREA AGRICULTURAL SERVICE, INC ( ) 01 FED ( ) 02 STATE ( l 03 LOCAL <br /> STREET A00 P.ESS . CITY STATE ZIP <br /> 1336 W. FREMONT ST. (DRAWER I) STOCKTON CA 95201 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> BREA AGRICULTURAL SERVICE. INC JACK BOZZANO <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 19783 E. MAIN HWY 26/WALL <br /> CITY COUNTY ZIP <br /> LINDEN SAN JOAQUIN 95236 <br /> MAILING ADDRESS CITY STATE ZIP <br /> P.O. BOX 40 LINDEN CA 95236 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-466-5911 ( J 01 GASOLINE STATION (X) 02 OTHER RETAIL FERTILIZERS <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIPRANGE SECTION <br /> 2 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(IAST NAME FIRST) AND PHONE W/AREACODE <br /> BOZZANO, JACK 209-931-0142 BOZZANO. JACK 209-931-0142 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( 1 04 OTHER: CONTAINER NUMBER 761-440-00 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1983 C. YEAR INSTALLED 1983 f 1 UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS f 1 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) 0.1 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> (X) 01 UNLEADED O 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( l 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1/4 ( ) GAUGE (X) INCHES ( ) CM ( ) UNKNOWN <br /> B. ( ) Ol VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. ( ) 01 CARBON STEEL f 1 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 1 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE l ] 10 NON-METALLIC <br /> ( ) 12 UNKNOWN. (X) 13 OTHER: MILD STEEL <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> • 0 <br />