Laserfiche WebLink
Y- <br /> STATE ID NUMBER <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND ST09AGE TANK 1 <br /> 1 1 <br /> 01 NEW PERMIT 1 1 05 RENEWED PERMIT l ) 07 TANK CLOSED l 1'09 DELETE FROM FILE (NO FEE) I <br /> I 1 02 CONDITIONAL PERMIT 1 1 06 AMENDED PERMIT f 1 06 MINOR CHANGE (HO SURCHARGE) J <br /> I OWNER f <br /> NAY.E IC OP 0RATION.IND IVIDUAI OR PVeLIC AGENCY) PUBLIC AGENCY ONLY <br /> 01 FED 1 ) 02 STATE f 1 03 LOCAL <br /> '§STREET ACORESS CITY STAT <br /> LF ZIP <br /> _ ,ofes C �'rT£YC X�. -- <br /> II FACILITY <br /> FACILITY NAME DEALER/FOPEMEN/SUPERVISOP <br /> R07z `L0o?f2 sf/� SvC. STFvE /fiEFf6/z <br /> STREET ACDIESS NEAREST CROSS STPEET <br /> CITY COUNTY ZIP <br /> Syoc.c�j oni f9Yl 93-2os- <br /> MAILING ADDRESS CITY STATE ZIP <br /> �d. /!o✓ '�/Tay � � STo��Tds- C'sf 9S-z/3 <br /> RHONE W'AREA CODE TYPE OF OUSINFSS <br /> - ? 01 GASOLINE STATION fK7 02 OTHER _ <br /> jwU SEP CF CONTAINERS AVP AI AREAS ONLY. TOWNSXI► RANGE SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> (DAYS: N:MEILAST NAME FIRST, AND PHONE 1/AEA CODE NIGHTS: NAME'LAST NAME FIRSTI AND PXONE WIAPEA CODE — <br /> �KiE'ifE/LJ <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> 1V DESCRIPTION <br /> 01 TANK f 1 02 OTHER: CONTAINER NUMBER <br /> B. MANUFACTURER (IF APPROPRIATE): U/I/I</yOz+A'�/ YEAR MFG: C. YEAR INSTALLEDIPr-01 1 1 UNKNOWN <br /> 0. CONTAINER CAPACITY: �O/ O¢fl GALLONS 1 1 UNKNOWN E. DOES THE CONTAINER STORE' ( 1 01 WASTE V'402 PRODUCT <br /> F DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (K01 YES l 102 NO IF YES CHECK APPROPRIATE BOX(ES1: <br /> IxL O1 UNLEADED l 1 02 REGULAR t ) 03 PREMIUM ( 1 04 DIE�SSEL_ ( 1 05 WASTE OIL i ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> II(A. TPICKNESS OF PRIMARY CONTAINMENT: //7 /NCH ( 1 GAUGE ( 1 INCHES 1 1 CM 1 1 UNKNOWN <br /> B. 1 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) 114" 02 NON-VAULTED 1 1 03 UNKNOWN <br /> IC. i-1 01 DOUBLE WILLED Oj6 02 SINGLE WALLED 1 1 03 LINED <br /> D. 0A 01 CARBON STEEL l 1 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE l 1 OS CONCRETE <br /> l 1 06 ALUMINUM l ) 07 STEEL CLAD l 1 OB BRONZE 1 1 09 COMPOSITE 1 1 10 NON-METALLIC <br /> ( 1 12 UNKNOWN ( 1 13 OTHER: <br /> IIiC04-07?185 PAGE 1 <br /> ` ' <br />