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0 • STATE ID NUMBER 00000005761001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> CLOSEDoel 01 NEW PERMIT 05 RENEWED PERMIT ( ) 07 TANK ) 09 DELETE FROM FILE (NO FEEL <br /> 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COP.PORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> ( 1 01 FED f 1 02 STATE ( 1 03 LOCAL <br /> M.K.T. FARMS <br /> CITY STATE ZIP <br /> STREET ADDRESS RIPON CA 95366 <br /> 18666 MELLO AVE. <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> SHOP ERIC JACOBSEN <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 19201 MELLO AVE. CARROLTON <br /> CITY COUNTY ZIP <br /> RIPON SAN JOAQUIN 95366 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 18666 MELLO AVE RIPON CA 95366 <br /> PHONE W/APEA CODE TYPE OF BUSINESS <br /> 209-599-2167 ( 1 O1 GASOLINE STATION (X1 02 OTHER VEHICLE MAINT. <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY . TOWNSHIP RANGE SECTION <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAM! FIRST) AND PHONE W/AREA CODE NIGHTS: NAMEILAST NAME FIRST) AND PHONE W/AREA CODE <br /> JACOBSEN,ERIC 209-599-2312 JACOBSEN,ERIC 209-599-2692 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER S1 <br /> B. MANUFACTURER (IF APPROPRIATE)= YEAR MFG: C. YEAR INSTALLED (X )UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( 1 O1 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 /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL ( 105 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f ) GAUGE f ) INCHES [ ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED f ) 02 SINGLE WALLED ( ) 03 LINED <br /> 0. (X) 01 CARBON STEEL f l 02 STAINLESS STEEL ( ] 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD f ) 08 BRONZE ( 1 09 COMPOSITE ( 1 10 NON-METALLIC <br /> ( 1 12 UNKNOWN ( 1 13 OTHER: <br /> PAGE 1 <br /> HSC04-070185 (10/18/85) <br /> Z <br />