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jw <br /> r .. : •0 <br /> STATE ID NUMBER 00000015479002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 01 NEW PERMIT ( 1 05 RENEWED PERMIT ( 1 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( l 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NA: (CCRPORATION.:NDIVIDU.AL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> ARCO PETROLEUM PRODUCTS COMPAN ( ) 01 FED ( ) 02 STATE f ) 03 LOCAL <br /> STREET ADDRESS c CITY -05 �p1e�es STATE ZIP1,Q6 -1 f <br /> 5 S . F ,div F�t� J 1�eeT s*wlmTm CA <br /> II FACILITY <br /> FACILITY NA'"- DEALER/FCPEM.AN.'SUPERVISOR <br /> SERPA'S lir�C(� �.H �pO O JOHN J. SERPA <br /> STPEET ADDRESS NEAREST CROSS STREET <br /> 85 E. LOUISE AVE. INTERSTATE #5 <br /> CITY COUNTY ZIP <br /> LATHROP SAN JOAQUIN 95330 <br /> MAILING A.DO=ESS CITYSTATE ZIP <br /> PHONE W-'A.REA CODE <br /> -TTX—)—o: <br /> YPE OF BUSINESS <br /> 209-858-2687 (X) O1 GASOLINE STATION ( ) 02 OTHER <br /> NUMBEP OF CONTAINERS 7P URAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAIS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) .AND PHONE W/AREA CODE <br /> Sf1�PA�7@fit�d - 7 J m yn <br /> �!l 1 1 -7 q�57 <br /> CO PLETE THE FOLL TE FORM F EACH CONTAINER — <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 2 <br /> B. MANUFACTURER (IF APPROPRIATE): OWENS CORNING FIBERGLASS YEAR MFG: 1984 C. YEAR INSTALLED 1984 ( l UNKNOWN <br /> D. CONTAINER CAPACITY: 12000 GALLONS ( l UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> 41 01 UNLEADED ( ) 02 REGULAR (, 0 EMIUM ( 1 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. (X) 01 DOUBLE WALLED ( 1 02 SINGLE WALLED ( ) 03 LINED <br /> D. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL (X) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( l 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />