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�.. `.� <br /> STATE ID NUMBER 00000058851001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( 1 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED (X1 09 DELETE FROM F (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARG <br /> I OWNER <br /> NAME(COPPORATION.INOIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> LIBBEY-OWENS-FORD COMPANY ( ) 01 FED ( ) 02 STATE ( ] 03 LOCAL <br /> STREET ADDRESS CITY STATE IIP <br /> 811 MADISON AVENUE, P.O. BOX 7 TOLEDO ON 43645 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> LATHROP PLANT 010 G. ROBERT MEYER <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 500 LOUISE AVENUE <br /> CITY COUNTY ZIP <br /> LATHROP SAN JOAQUIN 95330 <br /> MAILING ADDRESS CITY STATE ZIP <br /> P.O. BOX 128 LATHROP CA 95330 <br /> PHONE W/AREA CODE TYPEOF BUSINESS <br /> 209-858-5151 ( ) 01 GASOLINE STATION (X) 02 OTHER GLASS MFG. <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP P>NGE SECTION <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGMTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> MOWERY, ROBERT 209-477-8459 MOWERY, ROBERT 209-477-8459 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. f ) 01 TANK (X) 04 OTHER: -UMP CONTAINER NUMBER 3 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG:. C. YEAR INSTALLED 1964 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 40000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 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 /> ( 1 <br /> 01 UNLEADED ( ) 02 REGULAR ( 7 03 PREMIUM ( ) 04 DIESEL ( 1 05 WASTE OIL l ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 12 ( ) GAUGE (X) INCHES ( ) CM ( ) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( 1 03 UNKNOWN <br /> C. f ] 01 DOUBLE WALLED (XI 02 SINGLE WALLED ( ) 03 LINED <br /> D. ( ) 01 CARBON STEEL [ ) 02 STAINLESS STEEL f 7 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE (X) OS CONCRETE <br /> ( ) 06 ALUMINUM [ 1 07 STEEL CLAD f ) 08 BRONZE ( ) 09 COMPOSITE ( 1 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />