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STATE ID NUMBER 00000001276004 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> t 01 NEW PERMIT t H 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO,FEE) <br /> 02 CONDITIONAL PERMIT t ) 06 AMENDED PERMIT ( ) 06 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COP.PORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> JIM THORPE OIL INC ( ) 01 FED ( ) 02 STATE t } ,03 LOCAL' <br /> STREET ADDRESS CITY STATE ,ZIP <br /> 351 N BECKMAN RD LODE CA 95240 <br /> II FACILITY <br /> FACILITY NAME > r (� DEALER/FOREMAN/SUPERVISOR <br /> ! <br /> l RICHARD THORPE <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 351 N BECKMANRDLOCKFORD ST. <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESS CITY STATE ZIP <br /> PO BOX 3.57 LODI CA 95241 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-368-6175 C ) 01 GASOLINE STATION (X) 02 OTHER FUEL BULK PLANT <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> 12 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/APER CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> HORPE 209-368-6175 THORPE, RICHARD J. 209-369-7440 <br /> �u <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER. <br /> IV DESCRIP"TION <br /> A. (X) 01 TANK ( ) 04 OTHER= CONTAINER NUMBER 4 <br /> B. MANUFACTURER (IF APPROPRIATE): 'PERKINS WELDYEAR MEG: 1970 C. YEAR INSTALLED 1970' { ) UNKNOWN <br /> D. CONTAINER CAPACITY: 12000 GALLONS( )UNKNOWN JE. DOES THE CONTAINER STORE: t ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02NOIF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM -( ) 04 DIESEL t ) 05 WASTE OIL t } 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1/4 t ) GAUGE (X) INCHES ( ) CM ( ) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED t ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( D 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> t ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( H 10 -METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> MSC04-070185 (10/18/85) PAGE 1 <br />