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APPLICATION324 <br /> ( ) O1 NEW PERMIT FOR 05 RENEWEPERM <br /> ( ) 02 CONDITIONAL PERMIT IT TO OPERATE STATE <br /> ID <br /> ( ) D PERMIT UNDERGROUND NUMBER 00000021610001 <br /> RMI <br /> I ( ) O6 AMENOEO FERMI ( ) 07 TANK CLOSED STORAGE TANK <br /> ( ) US MINOR CHANGE <br /> MAME(DoeR ( 1 09 DELETE <br /> MARY OPA TION,rNDIvr)ugL (NO SURCHARGE) FROM FILE (NO FEE) <br /> BOWEN <br /> OR PUBLIC AGENCY) <br /> STREET AODRESS <br /> 25982 E. MILLER AVE <br /> PUBLIC AGENCY ONLY <br /> I I ( ) 01 FED ( <br /> FACILITY crrr ) 02 STATE <br /> ESCALON ( ) 03 LOCAL <br /> FACILITY STATE <br /> II <br /> NAN,E CA P <br /> MARY 80WEN 95320 <br /> $TREET ACCpESS DEALER/FOREMAN/SUPERVISOR <br /> 82 E MILLER AVE <br /> CITY NEAREST CROSS STREET <br /> ESCALON ESA LON BELLALO <br /> COUNTY <br /> "AILING ADDRESS SAN JOAQUIN <br /> 25982 E. MILLER AVEIIP <br /> clrY 95320 <br /> PHONE W/AREA CODE ESCALON <br /> h'P STAT I <br /> 209-838-7375 E OF BUSINESS E ZIP <br /> ( ) 01 GASOLINE STATIONCA 95320 <br /> N'JM3E P. OF CONTAINE:S ONLY • (X) 02 OTHER AGRICULTURE <br /> LTURE <br /> 1 rowNSHry <br /> 1S RANGE <br /> III 24 HOUR EMERGENCY CON T 9E s3orroN <br /> PERSON 33 <br /> FOATS: NAME(LAST NAME FIRST) AND PHONJ]PEA CODE <br /> BOWEN MARY 204-838-737j NIGHTS: NAME(LAST <br /> + AND PHONE W/AREA <br /> BOWEN MARY NAME PIPST) <br /> COMPLETE THE FOL[NG ON 209-838-7375 CODE <br /> A SEPARATE F <br /> IV DESCRIPTION ORM FOR EACH CONTAINER <br /> A. f ) 01 TANK (X) 04 OTHER: SUMP <br /> B. MANUFACTURER fIF APPROPRIATE): CONTAINER NUMBER 1 <br /> YEAR MFG: <br /> E• C YEAR INSTALLED <br /> 350 G( ) UNKNO <br /> D. CONTAINER CAPACITY: WN DOES THE CONigINER STORE: UNKNOWN <br /> (X) <br /> F. DOES THE CONTAINER STORE MOTOR FUEL OR WASTE OIL ? (X) O1 ( ) 01 WASTE <br /> f ) <br /> 01 UNLEADED (X) 02 REGULAj3 PREMIUM ( ) 04 DIESEL ( YES ( ) 02 NO Ip (X) 02 PRODUCT <br /> 05 WASTE OILYES CHECK APPROPRIATE BOX(ES): <br /> V CONTAINER CONSTRUC ( ) 96 OTHER <br /> A. THICKNESS OF PRIMARY CONTAINM ( ) GAUGE <br /> ( 1 INCHES ( ) CM (X) <br /> B. ( ) 01 VAULTED (LOCATED IN AiUND VAULT) UNKNOWN <br /> (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 02 DOUBLE WALLED (X) O�LLEO f 1 03 LINED <br /> D. (X) 01 CARBON STEEL [ ) 02STEEL ( ) 03 FIBERGLASS <br /> ( ) 06 ALUMINUM f 7 07 ) 08 BRONZE ( 11 04 POLYVINYL CHLORIDE ( ) <br /> ( ) 12 UNKNOWN ( 7 13 OTHf ( ) 09 COMPOSITE SO NON- 05 CONCRETE <br /> METALLIC <br /> HSC04-070185 (10/18/85) <br /> PAGE I <br />