Laserfiche WebLink
0 0 STATE ID NUMBER 00000046037002 <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 ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br />I OWNER <br />NAME(CORPOP,ATION,INDIVIOUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br />DON �& B-SLO fe MUNRO ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br />STREET A.DDPESS CITY STATE ZIP <br />LODI CA 95240 <br />II FACILITY <br />FACILITY NAME <br />(X) 01 TANK ( ) 04 OTHER: <br />DEALER/FOREMAN/SUPERVISOR <br />D A D MINI MART <br />NUMBER 2 <br />DON MUNRO <br />STREET ADDRESS <br />YEAR MFG: 1977 <br />NEAREST CROSS STREET <br />14971 N. HWY 88 <br />D. <br />KETTLEMAN LANE <br />CITY <br />CONTAINER STORE: ( <br />COUNTY <br />ZIP <br />LODI <br />01 YES ( ) 02 NO <br />( ) 05 WASTE OIL ( <br />SAN JOAQUIN <br />95240 <br />MAILING ADDRESS <br />CITY <br />STATE <br />ZIP <br />14971 N. HWY 88 <br />03 FIBERGLASS ( ) 04 <br />LODI <br />CA <br />95240 <br />PHONE W/AREAA CODE <br />[ ) 07 STEEL CLAD ( ) 08 BRONZE <br />TYPE OF BUSINESS <br />209-369-1844 <br />(X) 01 GASOLINE STATION ( ) 02 OTHER <br />NUMBER OF CONTAINERS <br />RURAL AREAS ONLY <br />TOWNSHIP <br />RANGE <br />SECTION <br />3 <br />III 24 HOUR EMERGENCY CONTACT PERSON <br />DAYS: N.AME(LAST NAME FIRST) AND PHONE W/AP.EA CODE NIGHTS: NAME(LAST NAME FIRST)AND PHONE W/AREA CODE <br />MUNRO, DON 209-369-1844 MUNRO, DON 209-333-8E49...?Z <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. <br />(X) 01 TANK ( ) 04 OTHER: <br />CONTAINER <br />NUMBER 2 <br />B. <br />MANUFACTURER (IF APPROPRIATE): PERKINS WELD WORKS <br />YEAR MFG: 1977 <br />C. <br />YEAR INSTALLED 1977 ( l UNKNOWN <br />D. <br />CONTAINER CAPACITY: 9980 GALLONS ( ) UNKNOWN <br />E. DOES THE <br />CONTAINER STORE: ( <br />) 01 WASTE (X) 02 PRODUCT <br />F. <br />DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) <br />( ) 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL <br />01 YES ( ) 02 NO <br />( ) 05 WASTE OIL ( <br />IF YES CHECK APPROPRIATE BOX(ES): <br />) 06 OTHER <br />V CONTAINER CONSTRUCTION <br />HSC04-070185 (10/18/85) <br />PAGE 1 <br />Q <br />A. <br />THICKNESS OF PRIMARY <br />CONTAINMENT: 1/4" ( <br />1 GAUGE (X) INCHES ( <br />) CM ( I UNKNOWN <br />B. <br />( l 01 <br />VAULTED (LOCATED IN AN UNDERGROUND VAULT) <br />(X) 02 NON -VAULTED ( <br />) 03 UNKNOWN <br />C. <br />( ) 01 <br />DOUBLE WALLED <br />(X) 02 SINGLE WALLED ( ) <br />03 LINED <br />D. <br />(X) 01 <br />CARBON STEEL <br />( ) 02 STAINLESS STEEL ( ) <br />03 FIBERGLASS ( ) 04 <br />POLYVINYLCHLORIDE ( ) 05 CONCRETE <br />[ ) <br />06 ALUMINUM <br />[ ) 07 STEEL CLAD ( ) 08 BRONZE <br />( l 09 COMPOSITE <br />[ ) 10 NON-METALLIC <br />( ) 12 <br />UNKNOWN ( ) <br />13 OTHER: <br />HSC04-070185 (10/18/85) <br />PAGE 1 <br />