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X(,e L STATE ID NUMBER 00000029962002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) 01 NEW PERMIT ( 1 05 RENEWED PERMIT C( 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEEL <br /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT (NO SURCHARGE) <br /> I OWNER <br /> NA"E(CORPORATION,INDIVIOUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> USDA-SCS ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET .ADDRESS CITY STATE ZIP <br /> 21001 N. ELLIOTT RD. LOCKEFORD CA 95237 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <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 /> LOCKEFORO SAN JOAQUIN 95237 <br /> M= .ING ADDRESS CITY STATE ZIP <br /> 21001 N. ELLIOTT RD. SAME CA 95237 <br /> PHONE W/ARE.A CODE TYPE OF BUSINESS <br /> 209-727-5319 ( ) 01 GASOLINE STATION (X) 02 OTHER PLANT TESTING FACILI <br /> N;:Y.3EP OF CONTAINERS RURAL AREAS ONLYTOWNSHIP RANGE SECTION <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> O.AYS: NAME(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. RAIMOND F. 209-369-9224 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 2 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR. INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 600 GALLONS [ l UNKNOWN E. DOES THE CONTAINER STORE: (X) 01 WASTE ( ) 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 /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( 1 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 5 ( l GAUGE (X) INCHES ( ) CM ( ) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( l 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED (X) 03 LINED <br /> D. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE (X) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( l 09 COMPOSITE ( 1 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />