Laserfiche WebLink
STATE I0 NUMBER 00000018582002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( 1 <br /> 01 NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 07 TANK CLOSEDl 09 DELETE FROM FILE (NO FEE) <br /> f 1 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHAR ) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> MEM MASONRY, INC. ( 1 O1 FED ( ) 02 STATE ( 1 03 LOCAL <br /> STREET ADDRESS CITY STATE IIP <br /> 395 INDUSTRIAL WAY DIXON CA 95620 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> MEM MASONRY EDGAR MERTZ <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 33 MAXWELL STREET STOCKTON <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILIN3 ADDRESS CITY STATE IIP <br /> 395 INDUSTRIAL WAY DIXON CA 95620 <br /> PHONE_ W/AREA CODE TI PE OF BUSINESS <br /> 916-678-3071 f ) 01 GASOLINE STATION (X) 02 OTHER MASONRY <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 2 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAIS: NAME(LAST NAME PIPST) AND PHONE W/AREA CODE NIGHTS: NMNAME FIRST) AND PHONE W/AREA CODE <br /> MERTZ,. EDGAR 209-368-3949 MERTZ, EDGAR 209-368-3949 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1977 f 7 UNKNOWN <br /> D. CONTAINER CAPACITY: 400000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: f l 01 WASTE fX) 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 ( ) 02 REGULAR ( ) 03 PREMIUM ( 1 04 DIESEL ( ) 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE 1 ) INCHES ( ) CM 1X1 UNKNOWN <br /> B. (X) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED f ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL f ) 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> f ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE l ) 09 COMPOSITE ( 7 10 NON-METALLIC <br /> ( 1 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> � i <br />