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' STATE ID NUMBER 09000009875001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> VPERMIT t ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> DITIONAL PERMIT ( 1 06 AMENDED PERMIT ( 1 08 MINOR CHANGE (NO SURCHARGE) <br /> R <br /> h (CORPOPATICN.:h3I%,I0UAl OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> R ELAM '!1 ( ) 01 FED ( 1 02 STATE [ 1 03 LOCAL <br /> S ET ADDRESS CITY STATE ZIP <br /> 2 S MCHENRT AVE ESCALON CA 95320 <br /> TI FACILITY <br /> ILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> FFNDLY CHEVROLET ROY ELAM <br /> S'{EET ADDRESS NEAREST CROSS STREET <br /> 2 S MCHENRY AVE KATHERINE WAY <br /> COUNTY ZIP <br /> ESCALON SAN JOAQUIN 95320 <br /> ING ADDRESS CITY STATE ZIP <br /> 2 S MCHENRY AVE ESCALON CA 95320 <br /> �tiONE W/AREA CODE TYPE OF BUSINESS <br /> 2cl838-7351 ( ) 91 GASOLINE STATION (X) 02 OTHER <br /> ti CR OF CONTAINERS RURAL AREAS ON=TOWNSHIP RANGE SECTION <br /> 3 L <br /> 24 HOUR EMERGENCY CONTACT PERSON <br /> ),YS NAME{LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> OY 209-838-7351 209-838-7167 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> DESCRIPTION <br /> (X) 01 TANK ( 1 04 OTHER CONTAINER NUMBER 2 <br /> RANUFACTURER (IF APPROPRIATE) MOWELCO YEAR MFG- 1965 C YEAR INSTALLED 1965 [ 1 UNKNOWN <br /> ONTAINER CAPACITY 550 GALLONS t ) UNKNOWN JE DOES THE CONTAINER STORE ( } 01 WASTE EX) 02 PRODUCT <br /> DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL 9 (X) 01 YES ( } 02 NO IF YES CHECK APPROPRIATE SOX(ES) <br /> (X) 01 UNLEADED t ) 02 REGULAR ( ) 03 PREMIUM [ l 04 DIESEL ( l 05 WASTE OIL f 1 06 OTHER <br /> CONTAINER CONSTRUCTION <br /> HICKNESS OF PRIMARY CONTAINMENT 12 (XI GAUGE t } INCHES ( ) CM ( ) UNKNOWN <br /> s t 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON—VAULTED ( ) 03 UNKNOWN <br /> 01 DOUBLE WALLED (X) 02 SINGLE WALLED f 1 03 LINED <br /> XI 01 CARBON STEEL ( } 02 STAINLESS STEEL f 1 03 FIBERGLASS [ ) 04 POLYVINYL CHLORIDE [ 105 CONCRETE <br /> ( ) 06 ALUMINUM [ 1 07 STEEL CLAD { ) 08 BRONZE ( 1 09 COMPOSITE t ) 10 NON—METALLIC <br /> 12 UNKNOWN [ 1 13 OTHER <br /> C 0185 (10/18/85) <br /> PAGE 1 <br />