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• �� • STATE ID NUMBER 00000037003002 ' <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) 01 NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME:E <br /> PO PATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> A.E. PEN ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREECDRESS18801MURPHY RD CITY STATE ZIP <br /> RIPON CA 95366 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> A.E. MEPPEN A.E. MEPPEN <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 18801 S MUR PHY. RD 120 HIWAY <br /> CITY <br /> COUNTY ZIP <br /> RIPON SAN JOAQUIN 95366 <br /> MAILING ADDRESS CITY <br /> 18801 S MURPHY RD STATE ZIP <br /> RIPON CA 95366 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-599-3484 ( ) 01 GASOLINE STATION (X) 02 OTHER AGRIC <br /> NUMBER OF CONTAINERS RURAL AR=ONLyOWNSHIP RANGE SECTION <br /> 2 2S 8E 5 <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 /> MEPPEN ARNOLD 209-599-3484 MEPPEN ARNOLD 209-599-3484 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK f 1 04 OTHER: CONTAINERNUMBER 2 <br /> B. MANUFACTURER (IF APPROPRIATE): M YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 340 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE ( 7 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES (X) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL f 1 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 12 (X) GAUGE ( l INCHES ( ) CM ( ) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN.AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03. UNKNOWN <br /> C. ( ). 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( 1 02 STAINLESS STEEL ( ) 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( 1 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) <br /> PAGE 1 <br />