Laserfiche WebLink
• STATE IO NUMBER <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> f l' 1 0 <br /> 1 NEW PERMIT l 1 OS RENEWED PERMIT l 1 07 TANK CLOSED l 1 09 DELETE' FROM FILE (NO FEE) <br /> 1 CONDITIONAL PERMIT --1-1 06 AMENDED PERMIT ( 1 08 MINOR CHANGE INO SURCHARGE) — <br /> I OWNER <br /> NAMEfCo PORATION.IN IDUAL QR FUSLIC AGE Y) PUBLIC AGENCY ONLY <br /> -,- � n I -n I� ,r,� Tr^n �� 1 1 01 FED 1 1 02 STATE ( ! 03 <br /> LOCAL—STREET ACTRESS �/(Y ����//�` STATE ZI <br /> zz <br /> II FACILITY <br /> FACILITY NAME DEALER/FOPEMEN/SUPERVISOP <br /> - Arco 2, 1 6 rev ty\ J <br /> S7Ff�apC'=ESS � ^ � NE ST CROSS STREET <br /> py5yli`'-11 p/1`-- /� <br /> CITY 1 -4z ►`�� COUNTY ZIP <br /> MAILING A DE S CITY S ATC 2IP <br /> � <br /> PHONE W•ACCR COo_E� , / TYPE OF GSILINE - <br /> �(( ( ) 01 GASOLINE STATION ( 1 02 OTHER <br /> NUrOER CF CONTAINEPS -- PUPAL AREAS ONLY :FIP PANGS SECTION <br /> 3—, j <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME IPST) NO PHONE W/ARCA CODE NIGHTS: NAME S NAM FIRST) AND PHON WiAREA CODE <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION — — <br /> A. 1�1 01 TANK ( 1 02 OTHER: CONTAINER NUMBER 3 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG. C. YEAR INSTALLED/Y7 ` ( ) UNKNOWN <br /> 0. CONTAINER CAPACITY: GALLONS ) UNKNOWN E. DOES THE CONTAINER STORE ( 1 O1 HASTE l —_ODUCT —— <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? 0 ES ( 1 02 NO LF YES CHECK APPROPRIATE BOXIEST: <br /> l 1 01 U1lLEAOED EGULAR ( 1 03 PREMIUM ( 1 04 DI L ( 1 05 WASTE OIL * 06 OTHER <br /> V CONTAINER CONSTRUCTION y <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ®� Z GAUGE (KI INCHES 1 1 CM l 1 UNKNOWN <br /> B. ( 1 01 VAULTED (LOCATED IH AN UNOERGROUND VAULT) l 02 NON-VAULTED 1 1 03 UNKNOWN <br /> IC. t 1 01 DOUBLE W1LLEO (X) 02 SItIGLE WALLED 1 1 03 LINED - - — — <br /> D. 1 101 CARBON STEEL ( ) 02 STAINLESS STEEL (�1FIBERGLASS ( ) 04 POLYVINYL CHLORIDE l 1 05 CONCRETE <br /> ( ) 06 ALUMINUM 1 ) 07 STEEL CLAD ( 1 08 Ol)ZE 1 ) 09 COMPOSITE ( 1 10 NON-METALLIC <br /> t 1 12 UNKNOWN l 1 13 OTHER: <br /> HSC04-0 0185 PAGE 1 <br />