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f2EPR0()UCED 1T C ✓ <br /> RA NT EXPENSE <br /> STATE ID NUMBER <br /> APPLICATION ,FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT l ) 06 AMENDED PERMIT ( ) 04 MINOR CHANGE (NO SURCHARGE) <br /> OWNER <br /> cKE(COPPORATION,INDIVIOUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> ( ) Ol FED l 1 02 STATE ( ) 03 LOCAL <br /> BEET A.C7RESS CITY <br /> STATE ZIP <br /> FACILITY <br /> CILITY NAME DEALER/FOREMEN/SUPERVISOR <br /> FEET ACC ESS NEAREST CROSS STREET <br /> T� COUNTY ZI P <br /> ILING ACDPESS CITY STATE ZIP <br /> ONE W,APEA CODE TYPE OF BUSINESS <br /> ( I <br /> 01 GASOLINE STATION ( ) 02 Alk OT <br /> t'BER CF CONTAINERS RURAL AREAS ONLY TOWNS IP RANGE SECTION <br /> : I 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 /> COMPLETE THE FOLLOWIPDA S T FORM FOR EACH CONTAINER <br /> DESCRIPTION <br /> ( ) 01 TANK ( ) 02 OTHER: CONTAINER NUMBER <br /> MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED ( ) UNKNOWN <br /> CONTAINER CAPACITY: a GALLONS ( l UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (2Q'02 PRODUCT <br /> DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (K< 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) <br /> 01'UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM (-Y 04 DIESEL ( ) 05 WASTE OIL t 1 06 OTHER <br /> CONTAINER CONSTRUCTION <br /> THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM ( ) UNKNOWN <br /> t 1 <br /> 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( 1 02 NON-VAULTED ( ) 03 UNKNOWN <br /> ( ) <br /> 01 DOUBLE WALLED ( l 02 SINGLE WALLED ( ) 03 LINED <br /> ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> t ) 12 UNKNOWN ( ) 13 OTHER: <br /> :04-070185-- --- PAGE 1 <br />