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i <br /> STATE ID NUMBER 00000019674002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> oO1 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 /> NAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> AGRI BIS INC f ) 01 FED l ) 02 STATE f 1 03 LOCAL <br /> STPEET ADDRESS CITYSTATE ZIP <br /> 1120 W CHARTER WAY STOCKTON CA 95206 <br /> II FACILITY <br /> [FACZLITY NAME DEALER/FOREMAN/S RVZSOR <br /> AL TRACTORT ADDRESS NEAREST CROSS STREET <br /> W CHARTER WAY ARGONAUT <br /> COUNTY ZIP <br /> TON SAN JOAQUIN 95206 <br /> MAILING ADDRESS CITYSTATE ZIP <br /> P.O. BOX 6069 STOCKTON CA 95206 <br /> PHONE W/AP.EA CODE TYPE OF BUSINESS <br /> 209-944-5714 f ) 01 GASOLINE STATION (X) 02 OTHER EQUIP DEALER <br /> NUMBER OF CONTAINEPS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> �v <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> 7AY3: NAME(LAST NAME FIRST) AND PHONE W/ARCA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> f 209-944-5714 OW4-66ORSe 209-931=.r' - <br /> 1 a-i <br /> ETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( 1 04 OTHER: CONTAINER NUMBER 102 <br /> S. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1973 ( 7 UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 GALLONS 1 ) UNKNOWN I E. DOES THE CONTAINER STORE: f ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> (X) 01 UNLEADED ( 1 02 REGULAR f 1 03 PREMIUM ( ) 04 DIESEL ( 1 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. 1 1 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( 1 03 LINED <br /> D. f 1 01 CARBON STEEL ( ] 02 STAINLESS STEEL ( 1 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD f 108 BRONZE f 1 09 COMPOSITE ( ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />