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' STATE ID NUMBER oDDOOD09875002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> l 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( 1 07 TANK CLOSED [ ) 09 DELEtE FROM FILE (NO FEE1 <br /> 02 CONDITIONAL PEkMIT ( 1 06 AMENpED PERMIT ( ) 08 MINOR CHANGE [NO SURCHARGE) <br /> I OWNER <br /> ti (CORPOPATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> ROY ELAM ( 1 01 FED ( ) 02 STATE ( 1 03 LOCAL <br /> S ET ADDPESS CITY STATE ZIP <br /> z S MCHENRY AVE ESCALON CA 95320 <br /> I FACILITY <br /> 'a LITY NAME DEALER/FOREMAN/SUPERVISOR <br /> FRIENDLY CHEVROLET ROY ELAM <br /> ,T ET ADDRESS NEAREST CROSS STREET <br /> '9 S MCHENRY AVE KATHERINE WAY <br /> ITY COUNTY ZIP <br /> o" SAN JOAQUIN <br /> 95320 <br /> -1110 ADDPESS CITY JCA <br /> E ZIP <br /> '996 S MCHENRY AVE ESCALON 95320 <br /> H _ W/„REA CODE TYPE OF BUSINESS <br /> I '0 38-7351 ( 1 01 GASOLINE STATION (X) 02 OTHER <br /> JygER OF CONTAINERS RURAL AREAS ONLY 70WNSNIP RANGE SECTION <br /> 3 -J <br /> II 24 HOUR EMERGENCY CONTACT PERSON <br /> AME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> t OY 209-838-7351 209-838-7167 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FDR EACH CONTAINER <br /> V, DESCRIPTION <br /> 1 01 TANK ( 1 04 OTHER CONTAINER NUMBER 3 <br /> MANUFACTURER (IF APPROPRIATE) MOWELCO YEAR MFG 1965 C YEAR INSTALLED 1965 ( } UNKNOWN <br /> LTAINER CAPACITY 340 GALLONS ( l UNKNOWN JE DOES THE CONTAINER STORE (X) 01 WASTE ( l 02 PRODUCT <br /> DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ° (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE SOX(ES) <br /> 01 UNLEADED f ) 02 REGULAR ( l 03 PREMIUM ( } 04 DIESEL (X) 05 WASTE OIL ( 1 06 OTHER <br /> CONTAINER CONSTRUCTION <br /> lICKNESS OF PRIMARY CONTAINMENT: 12 1Xl GAUGE ( ) INCHES ( 1 CM ( I UNKNOWN <br /> 01 VAULTED (�OCATED IN AN UNDERGROUND VAULT (X) 02 NON-VAULTED ( 1 03 UNKNOWN <br /> t 1 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( 1 03 LINED <br /> 1 01 CARBON STEEL ( ) 02 STAINLESS STEEL [ ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE [ 1 05 CONCRETE <br /> 3 06 ALUMINUM ( ) 07 STEEL CLAD ( } 08 BRONZE ( 1 09 COMPOSITE f ) 10 NON-METALLIC <br /> 2 UNKNOWN f 1 13 OTHER- <br /> 070185 (30/18/85) <br /> PAGE 1 <br /> j - <br />