Laserfiche WebLink
* STATE ID NUMBER 00000046037003 <br />APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br />(�) <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 />IN.AME(CORPORATION.INDIVIDUAL OR PUBLIC .AGENCY) PUBLIC AGENCY ONLY <br />OON &-DekeRtS MUNRO ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br />STREET ADDRESS )� 1� CITY STATE ZIP � i1//lT �� LODI ICA 195240 <br />'II FACILITY <br />FACILITY NAME <br />(X) 01 TANK ( ) 04 <br />DEALER/FOREMAN/SUPERVISOR <br />) CM ( ) UNKNOWN <br />D & D MINI MART <br />CONTAINER <br />DON MUNRO <br />B. <br />STREET ADDRESS <br />WELD. WORKS <br />NEAREST CROSS STREET <br />C. <br />14971 N. HWY 88 <br />D. <br />KETTLEMAN LANE <br />9980 GALLONS ( <br />CITY <br />E. DOES THE CONTAINER STORE: ( <br />COUNTY <br />F. <br />ZIP <br />LODI <br />FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO <br />PREMIUM (X) 04 DIESEL ( ) 05 WASTE OIL ( <br />SAN JOAQUIN <br />95240 <br />MAILING ADDRESS <br />CITY <br />STATE <br />ZIP <br />14971 N. HWY 88 <br />LODI <br />CA <br />95240 <br />PHONE W/APEA CODE <br />TYPE OF BUSINESS <br />209-369-1844 <br />(X) 01 GASOLINE STATION f l 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 />,AYS: NAME(L.AST NAME FIRST) AND PHONE W/AP.EA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br />IUNRO, DON 209-369-1844 MUNRO, DON 209-333-9e4O122?_, <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. <br />(X) 01 TANK ( ) 04 <br />OTHER= <br />) CM ( ) UNKNOWN <br />B. <br />CONTAINER <br />NUMBER 3 <br />B. <br />MANUFACTURER (IF APPROPRIATE): PERKINS <br />WELD. WORKS <br />YEAR MFG: 1977 <br />C. <br />YEAR INSTALLED 1977 ( ) UNKNOWN <br />D. <br />CONTAINER CAPACITY: <br />9980 GALLONS ( <br />) UNKNOWN <br />E. DOES THE CONTAINER STORE: ( <br />) 01 WASTE (X) 02 PRODUCT <br />F. <br />DOES THE CONTAINER <br />( ) 01 UNLEADED ( <br />STORE MOTOR VEHICLE <br />) 02 REGULAR ( ) 03 <br />FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO <br />PREMIUM (X) 04 DIESEL ( ) 05 WASTE OIL ( <br />IF YES CHECK APPROPRIATE BOX(ES): <br />) 06 OTHER <br />V CONTAINER CONSTRUCTION <br />A. <br />THICKNESS OF PRIMARY CONTAINMENT: 1/4" <br />( ) GAUGE (X) INCHES ( <br />) CM ( ) UNKNOWN <br />B. <br />( ) <br />01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON -VAULTED ( <br />) 03 UNKNOWN <br />C. <br />( ) <br />01 DOUBLE WALLED (X) 02 SINGLE WALLED t <br />) 03 LINED <br />D. <br />(X) <br />( ) <br />01 CARBON STEEL ( l 02 STAINLESS STEEL ( <br />( ) 06 ALUMINUM t l 07 STEEL CLAD ( 1 08 <br />12 UNKNOWN ( ) 13 OTHER: <br />) 03 FIBERGLASS ( ) 04 <br />BRONZE ( 1 09 COMPOSITE <br />POLYVINYL CHLORIDE f ) 05 CONCRETE <br />( ) 10 NON-METALLIC <br />HSC04-070185 (10/18/85) <br />0 46 <br />PAGE 1 <br />