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• • STATE ID NUMBER 00000009584001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> vy�01 NEW PERMIT ( ) 05 RENEWED PERMIT I 1 07 TANK CLOSED <br /> ( ) 09 DELETE FROM FILE (NO FEE) <br /> l�f 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( 1 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> PUBLIC AGENCY ONLY <br /> NAME(COP.PORATION,:NDIVIDUAL OR PUBLIC AGENCY) ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> CASE CONSTRUCTION CO INC. M <br /> CITY STATE ZIP <br /> STREET ADDRESS LODI CA 95240 <br /> 520 SO. MAIN <br /> II FACILITY <br /> FACILITY NAME M � S..t. �v.1('U I3tl O) DEALER/FOREMAN/SUPERVISOR <br /> ��( GE <br /> SAILS <br /> NEAREST CROSS STREET <br /> STREET ADDRESS <br /> 520 S. MAIN ST. <br /> COUNTY ZIP <br /> CITY <br /> LODI SAN JOAQUIN 95240 <br /> CITY STATE ZIP <br /> MAILING ADDRESS CA 95240 <br /> 520 S. MAIN ST. LODI <br /> PNUMBEP <br /> /AREA CODE TYPE OF BUSINESS <br /> 33y— 6 Iv / ( ) O1 GASOLINE STATION lX) 02 OTHER <br /> OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP <br /> RANGE SECTION <br /> 1 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME T NAME FIRST) AND PH W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> gE. 334- I�-'��0� BETTY CASE 334-540 <br /> PR, cry <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X1 01 TANK f 1 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE).: UNKNOWN YEAR MFG: C. YEAR INSTALLED 1972 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 500 GALLONS l 1 UNKNOWN E. DOES THE CONTAINER STORE: t ) 01 WASTE (X1 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES f 1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED fX) 02 REGULAR ( ) 03 PREMIUM ( 1 04 DIESEL ( ) 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f ) GAUGE ( ] INCHES ( ) CM (X) UNKNOWN <br /> 8. [ ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) f ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. f ) 01 DOUBLE WALLED f ) 02 SINGLE WALLED ( ) 03 LINED <br /> D., ( 1 01 CARBON STEEL ( ) 02 STAINLESS STEEL f 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( 105 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD t ) 08 BRONZE l ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> PAGE 1 <br /> HSC04-070185 (10/18/85) <br /> ! 10 <br /> 40 <br />