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STATE ID NUMBER 00000029962001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( 1 07 TANK CLOSED ( 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( l 06 AMENDED PERMIT ( 1 08 MINOR CHANGE (NO SURCHARG ) <br /> I OWNER <br /> NAME(COP,PORATION,INOIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> USDA-SCS ( ) 01 FED ( ) 02 STATE ( l 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 21001 N. ELLIOTT RD. LOCKEFORD CA 95237 <br /> II FACILITY <br /> FACILITY NAME DEALER./FOREMAN/SUPERVISCR <br /> PLANT MATERIALS CENTER RAIMOND F. CLARY, JR. <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 21001 N. ELLIOTT RD. HWY 88 <br /> CITY COUNTY ZIP <br /> LOCKEFORD SAN JOAQUIN 95237 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 21001 N. ELLIOTT RD. SAME CA 95237 <br /> PHCNE W/AREA CODE TYPE OF BUSINESS <br /> 209-727-5319 ( ) 01 GASOLINE STATION (X) 02 OTHER PLANT TESTING FACILI <br /> NUFISER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: N.AME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> CLARY, JR. RAIMOND F. 209-727-5319 CLARY, JR. RAIMONO F. 209-369-9224 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> I <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: 500 GALLONS ( 1 UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 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 /> ( l 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( l GAUGE ( l INCHES ( ) CM (X) UNKNOWN <br /> B. ( l 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS t ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( 1 09 COMPOSITE ( 1 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />