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Qo <br /> STATE ID NUMBER 00000009899001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( nl NEW PERMIT ( ) 05 RENEWED PERMIT 00 0 LOS ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( 1 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAF1E(CORPORATZON.iNDIVIOUALR PUBLIC A ENCY) PUBLIC AGENCY ONLY <br /> L PUBLIC <br /> f ) 01 FED f ) 02 STATE ( 1 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 240 N. CHEROKEE LN. LOOI CA 95240 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> LODI TIRE SERV. <br /> STREET ADDRESS ]�r� NEAREST CROSS STREET <br /> / & LOCKEFORD ST. <br /> CITY <br /> COUNTY ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESS CITU STATE IIP <br /> 240 N. CHEROKEE LN. LODI CA 95240 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-369-1985 ( ) 01 GASOLINE STATION (X) 02 OTHER TIRE SHOP(OWR USE ON <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANO! SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME( AST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME- FIRST) AND PHONE W/AREA CODE <br /> PARSONS ED 209-444-0445- <br /> PARSONS 209-564-}995 (O <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 500 GALLONS ( ] UNKNOWN E. DOES THE CONTAINER STORE: f ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (XI 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( 1 INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE ( l 05 CONCRETE <br /> ( ) 06 ALUMINUM [ ) 07 STEEL CLAD ( ) 08 BRONZE ( l 09 COMPOSITE ( 1 10 NON-METALLIC <br /> f ) 12 UNKNOWN l ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />