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\� STATE 10 NUMBER 00000011683001 <br /> J APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> c?.1 01 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 /> NAMl(COFFOFATION.-.ND iV ID UAL OR PVBLIC AGENCY) PUBLIC AGENCY ONLY <br /> SANBORN CHEVROLET INC f ) 01 FEC ( ) 02 STATE ( 1 03 LOCAL <br /> STREET ADDRESSCITY STATE ZIP <br /> 1210 SO CHEROKEE UN LODI CA 95240 <br /> II FACILITY <br /> FACILITY NAM'- DEALER/FOREMAN/SUPERVISOR <br /> SANBORN CHEVROLET INC STtyE—DyCMMF6.6H.p L G� <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1210 SO CHEROKEE LN KETTL€MAN <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 1210 SO CHEROKEE LN LODI CA 95240 <br /> PHONE W/APEA CODE TYPE OF BUSINESS <br /> 209-334-5000 ( 7 01 GASOLINE STATION (Xl 02 OTHER AUTO DEALER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 2 <br /> 1II 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> 209-334-5000 209-9Gi—"s2-7 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER GAS 1 <br /> B. MANUFACTURER (IF APPROPRIATE): UNK YEAR MFG: 1973 C. YEAR INSTALLED 1973 ( ) UNKNOWN <br /> 0. CONTAINER CAPACITY= 1000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES f 7 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> (X) 01 UNLEADED ( ) 02 REGULAR ( 1 03 PREMIUM ( ) 04 DIESEL f 1 05 WASTE OIL ( l 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 10 (X) GAUGE ( 1 INCHES ( ) CM ( ) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( 7 03 LINED <br /> D. (X) 01 CARBON STEEL l l 02 STAINLESS STEEL ( 1 03 FIBERGLASS f l 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> f ) 06 ALUMINUM ( 7 07 STEEL CLAD ( 1 08 BRONZE l ) 09 COMPOSITE f ) 10 NON-METALLIC <br /> ( 7 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> l <br />