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STATE ID NUMBER 00000058140001 <br /> APPLICATION FOR PERMIT T DERGROUND STORAGE TANK <br /> ( I <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( 1 02 CONDITIONAL PERMIT t 1 06 AMENDED PERMIT ANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> LODI UNIFIED SCHOOL DISTRICT ( ) 01 FED ( ) 02 STATE 1 ) 03 LOCAL <br /> STREET ADDRESS CITY STAT! IIP <br /> 815 WEST LOCKEFORD ST. L001 CA 95240 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> TOKAY HIGH SCHOOL LEONARD FISCHER <br /> STREIT ADDRESS NEAREST CROSS STREET <br /> 1111 WEST CENTURY BLVD. HAM -LANE <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 813 WEST LOCEFORD ST. LODI CA 95240 <br /> PHONE W/ARIA CODE TYPE OF BUSINESS <br /> 209-334-2654 t ) 01 GASOLINE STATION (X) 02 OTHER SCHOOL <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 1 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAMC(LAST NAME FIRST? AND PRONE W/AREA COD! NIGHTS: NAME NAME FIRST) AND PHONE W/AREA CODE <br /> FISCHER. LEONARD 209-369-1242 FISCHER, LEONARD 209-333-1565 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK f 1 04 OTHER: CONTAINER NUMBER TH-D <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1977 C. YEAR INSTALLED 1977 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS f 1 UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? fX) 01 YES ( ) 02 ND IF YES CHECK APPROPRIATE BOX(ES): <br /> l ) 01 UNLEADED f ) 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL ( 1 05 WASTE OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: .250 ( ) GAUGE (X) INCHES ( ) CM ( ) UNKNOWN <br /> S. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UWNOW14 <br /> C. ( 1 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ] 03 LINED <br /> 0. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL f 1 03 FIBERGLASS ( 7 04 POLYVINYL CHLORIDE ( 7 05 CONCRETE <br /> f ) 06 ALUMINUM ( 1 07 STEEL CLAD ( ) OB BRONZE ( ] 09 COMPOSITE f 1 10 NON-METALLIC <br /> f ) 12 UNKNOWN ( 1 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />