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0 0 STATE IO NUMBER 00000009875003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> f�Q 01 NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 1 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPOR N,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> TIO <br /> ( ) O1 FED t 1 02 STATE ( ) 03 LOCAL <br /> ROY ELAM <br /> CITY STATE ZIP <br /> STREET ADDRESS <br /> ESCALON CA 95320 <br /> 2966 S. MCHENRY AVE. <br /> II FACILITY <br /> FACILITY NAME DEALEP/FOREMAN/SUPERVISOR <br /> FRIENDLY CHEVROLET ROY ELAM <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 2996 S. MCHENRY AVE. KATHERINE WAY <br /> COUNTY ZIP <br /> CITY <br /> ESCALON SAN JOAQUIN 95320 <br /> CITY STATE ZIP <br /> MAILING ADDRESS <br /> ESCALON CA 9532 <br /> 2996 S. MCHENRY AVE. 0 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-838-7351 ( ) 01 GASOLINE STATION (X) 02 OTHER <br /> NUMBER. OF CONTAINERS RURA�APIAS NLY <br /> To <br /> RANGE SECTION <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND-PHONE W/AREA CODE <br /> ELAM, ROY 209-838-7351 <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): MOWELCO YEAR MFG: 1965 C. YEAR INSTALLED 1965 ( l UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 GALLONS ( 1 UNKNOWN I E. DOES THE CONTAINER STORE: ( 1 01 WASTE (X) 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 ( l 04 DIESEL ( 1 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 12 (X) GAUGE ( I INCHES ( ) CM ( 1 UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( I 01 DOUBLE WALLED (X) 02 SINGLE WALLED [ 1 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( 108 BRONZE ( 1 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> PAGE 1 <br /> HSC04-070185 (10/18/85) <br />