Laserfiche WebLink
. . STATE ID NUMBER 1694 zoo 9• <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> y(1 O1 NEW PERMIT 1 1 05 RENEWED PERMIT t ) 07 TANK CLOSED - f ) 09 DELETE FROM FILE (NO HE]) <br /> 1 1 02'TVWITIO14AL PERMIT t ) 06 AMENDED PERMIT f ) 00 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAY.EICOPPORATION.INCIV�11OOUAL OR FU0l2C AGENC 1 PUBLIC AGENCY ONLY <br /> Iv/G 1-� �,�T 1 1 Ol FED t 1 02 STATE 03 LOCAL <br /> STREET AC -- —_ �� �—/—_ <br /> �ITY STATE 2 p Gici� <br /> II FACILITY <br /> FACILITY NA.-.%NAM <br /> OEAIER/FOREMEN�UPERVISOP <br /> -- T A—t AIL S 62 l//G G _ J!4 1 /lel c :C. P-t-7 l4 <br /> STREET ACCESS � I <br /> —— _ _ 7 6—� 7 <br /> CITY NEAREST CROSS STREET <br /> (�/+�J' /�) J `/ / K^� (� <br /> COUNTY ZIP <br /> `iD/ /6 V,� 2IP �J <br /> rM4IlING PDDPES `/ CCITYSTATE ZTP <br /> PHONE WIAPEA CODE 1/// / �y� TYPE OF OUSIN'-SS <br /> '�G� D % 1� -( — 6 7L} b f ) 01 GASOLINE STATION f 1 02 OTHER <br /> NUrDER CF CONTAINEPS PUPAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> GAYS: NAMEILAST NAME FIPST) ANO PHONE W/APER CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/APEA CODE <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. <br /> ( O1 TANK ( 1 02 OTHER: CONTAINER NUMBER <br /> A. <br /> ^ <br /> B. MANUFACTURER (IF APPROPRIATE)! _ _ YEAR MFG C. YEAR INSTALLED �9 6 1 ) UNKNOWN <br /> 0. CONTAINER CAPACITY: GALLONS 1 1 UNKNOWN E. DOES THE CONTAINER STORE: f 1 01 WASTE 1 1 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES 1 1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( 6 01 Uf4EADED l 1 02 REGULAR ( 1 03 PREMIUM 1 1 04 DIESEL Cf/,05 WASTE OIL l ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1 ) GAUGE ( ) INCHES f 1 CM 1 1 UNKNOWN <br /> iB. f 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) l 2 NON-VAULTED f l 03 UNKNOWN <br /> tC. I 1 01 DOUBLE WILLED vvv,J A2 SINGLE WALLED 1 1 03 LINED <br /> 0. 1 1 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FI6ERGLASS ( 1 04 POLYVINYL CHLORIDE 1 ) 05 CONCRETE <br /> J( 1 06 ALUMINUM l 1 07 STEEL CLAD ( 1 08 BRONZE 1 1 09 COMPOSITE ( 1 10 NON-METALLIC <br /> i J 1 UNKNOWN ( 1 13 OTHER: <br /> PAGE 1 <br />