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,% / .-,STATE ID NUMBER 00000011683002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> O1 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED l ) 09 DELETE FROM FILE (NO FEET <br /> ( 1 02 CONDITIONAL PERMIT f ) 06 AMENDED PERMIT f ) O8 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPCRATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> SANBORN CHEVROLET INC I( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE IIP <br /> 1210 SO CHEROKEE LN LODI CA 95240 <br /> I-I FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPE VISOR <br /> SANBORN CHEVROLET INC � � <br /> STPEET ADDRESS NEAREST CROSS STREET <br /> 1210 SO CHEROKEE LN KETTLEMAN <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESS CITYSTATE ZIP <br /> 1210 SO CHEROKEE LN LODI CA 95240 <br /> PHONE W/AREA CODE TYPEOF BUSINESS <br /> 209-334-5000 ( ) 01 GASOLINE STATION (X) 02 OTHER AUTO DEALER <br /> NUMBER. OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 2 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME LAST NAME FIRST) AND PHONE W/ARCA CODE <br /> aTr#&4we+RtE -i <br /> rtttR- 209-334-5000 3IFMBWGWHf4AXR 209-951- 85t -?L(s� <br /> -COMPLETE THE FOLLOWING ON A SEPARATE F EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER W01 <br /> B. MANUFACTURER (IF APPROPRIATE): UNK YEAR MFG 1973 C. YEAR INSTALLED 1973 ( 7 UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 GALLONS ( 7 UNKNOWN E. DOES THE CONTAINER STORE: (X) 01 HASTE t ) 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 /> f I <br /> 01 UNLEADED ( 1 02 REGULAR ( ) 03 PREMIUM f ) 04 DIESEL (X) 05 WASTE OIL ( l 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 10 (X) GAUGE f 1 INCHES ( ) CM ( ) UNKNOWN <br /> B. ( 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED f ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( 1 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ] 04 POLYVINYL CHLORIDE f 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( 1 09 COMPOSITE l ) 10 NON-METALLIC <br /> l ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />