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STATE ID NUMBER 00000050198001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> l ) <br /> 01 NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED 09 DELETE FROM FILE (NO FEE) <br /> 1 102 CONDITIONAL PERMIT l ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CCPPOPATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> LUSTRE-CAL NAMEPLATE CORPORATI ( ) 01 FED 1 ) 02 STATE ( 1 03 LOCAL <br /> STREET ADDFESS CITY STATE 2IP <br /> 110 E. TURNER RD. LODI CA 95240 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> LUSTRE-CAL NAMEPLATE CORPORATI cA JIM A. KERBS <br /> STREET ACDF'-SS NEAREST CROSS STREET <br /> 110 E. TURNER RD. STOCKTON <br /> CITY u COUNTY ZIP <br /> LODI SAN JOAGUIN 95240 <br /> MAILING ADDRESSCITY STATE ZIP <br /> P.O. BOX 439 LODI CA 95240 <br /> PHONE W/AREA CODE TPP'- OF BUSINESS <br /> 209-334-6263 1 l 01 GASOLINE STATION (XI 02 OTHER LABEL MANUFACTURER <br /> NL'Y.BER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 1 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: R4ME(LAST NAME FIRST) AND PHONE W/AFEA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> KERBS, JIM A. 209-368-7814 KERBS, JIM A. 209-368-7814 <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: 28000 GALLONS 1 1 UNKNOWN E. DOES THE CONTAINER STORE: (XI 01 WASTE ( 1 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES (X) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( 1 02 REGULAR ( ) 03 PREMIUM ( 1 04 DIESEL I 1 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 12 ( ) GAUGE 1X1 INCHES ( 1 CM 1 I UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) [ 1 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED f 1 02 SINGLE WALLED f 1 03 LINED <br /> D. ( ) 01 CAP.BON STEEL ( 1 02 STAINLESS STEEL f 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE (X) 05 CONCRETE <br /> 1 1 06 ALUMINUM ( ) 07 STEEL CLAD l 108 BRONZE 1 1 09 COMPOSITE 1 1 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( 1 13 OTHER: <br /> MSC04-070185 (10/18/85) PAGE 1 <br />