Laserfiche WebLink
STATE ID NUMBER <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> IJ1 <br /> 01 NEW PERMIT ( I OS RENEWED PERMIT l ) 07 TANK CLOSED -- — — ( ) 09 OELETE' FROM FILE (NO FEE) <br /> Kwe,- COIIOITIONAL PERMIT I-1 06 AMENDED PERMIT ( 1 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAM..t(COPPORATION.INCIVIOU4L O,/R� FUDIIC AGENCY) LI PUBLIC AGENCY ONLY <br /> _--_--._— Arco T�.e�r4' � ...'c- �Yo���S Co. _ l I O1 FEO 1 1 02 STATE— ( ) 03 LOCAL_ <br /> STcEf7 ACI)4'.SSCITY STATE ZIP <br /> ---- - --- 5'l — 41, 1 - C h l oo 7 <br /> II FACILITY <br /> FACILITY NA—.E ��, DEALER/FOPEMEN/SUPERVISOP <br /> ,� <br /> -----�o -- — <br /> STREET ACCESS NEAPEST CROSS STPEET <br /> ---- - - - 3 2 2. AL Cu A _- <br /> CITY COUNTY ZIP <br /> Gvn JOU !��vT <br /> MAI)ING ADD <br /> PE ` c y) VwYL STATE ZIP Ll Y 6 <br /> PHONE W'AcEA CODE TYPE CF BUSINESS <br /> l�l 01 GASOLINE STATION ( 1 02 OTHER <br /> NUPoBEP CF CONTAINEcS PUPAL APEAS ONLY ; TOWNSHIP RANGE SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> rGAYS: NAM,E(LAST NAME FIPST) ANO PHONE W/APER CODE NIGHTS: NAME(LAST NAME FIRST) ANO PHONE W/AREA CODE r <br /> l�_ Sec�u ti - -�6r7 6 _ 0 2- 1 57 4ec�, <br /> i 1 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. ( TA)IK ( 1 02 OTHER: CONTAINER NUMBER <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED /Y 7 Z( 1 UNKNOWN <br /> 0. CONTAINER CAPACITY: GALLONS ( UNKNOWN E. DOES THE CONTAINER STORE: ( 1 01 WASTE ) 02 PRODUCT <br /> F DOES THE CONTAINER STORE MOTOR VEHI LE FUEL OR WASTE OIL ? ( J0.1-YES t 1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> 1 1 <br /> 01 U'lLEADEO ( 1 02 REGULAR 03 PREMIUM ( 1 04 OIE 1 1 05 WASTE OIL 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PP.IMARY CONTAINMENT: C�, Z 5-0 ( I GAUGE O . IN6.HES ( 1 CM 1 1 UNKNOWN <br /> B. 1 1 01 VAULTED (LOCATED IN AN UNOERGROUNO VAULT E-"PION-VAULTED I 1 03 UNKNOWN <br /> IC. ( 1 01 DOUBLE W1LLEO IXL 0 .SINGLE WALLED ( 1 03 LINED <br /> ID. 1 1 01 CARBON STEEL 1 1 02 STAINLESS STEELf 1 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE l 1 05 CONCRETE <br /> ( ) Ob ALUMINUM l 107 STEEL CLAD ( 1 0 ROtlu 1 109 COMPOSITE ( 1 10 NON-METALLIC <br /> l ) 12 UNKNOWN l 1 13 OTHER: <br /> - - -- ------------- - - ----- -------- <br /> HSC04-070185 PAGE 1 <br />