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0 <br /> STATE I0 NUMBER 00000049637003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> (JTO1 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 /> NA.ME(COP.POP.ATION.INDIVIDUAL OR PCY) PUBLIC AGENCY ONLY <br /> BO�LgI UBLIC AGEN ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS ' / CITY STATE iIP <br /> 6BRBKSi-k#F. '})30 Ut).. ®f L(f LODI CA 95240 <br /> II FACILITY <br /> FACILITY N=ME DEALER/FOREMAN/SUPERVISOR <br /> PLAZA LIQUORS R9M-9A1iCER Torn 6vaves c� )- v""'J <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 800 S. CHEROKEE LN. MAPLE <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 800 S. CHEROKEE LODI CA 95240 <br /> D <br /> PHONE 'A;ATEA CODE TYPE OF BUSINESS <br /> 209-368-0127 (X) 01 GASOLINE STATION f ) 02 OTHER <br /> NUMBER. OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST YME FIRST) AND PHONE WW/AREA CODE <br /> "11- �_%M6t-A.✓@s _yl�S_ S/ SAME r Yid 65..p <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): PERKINS YEAR MFG: 78 C. YEAR INSTALLED 1978 f 1 UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS ( 1 UNKNOWN E. DOES THE CONTAINER STORE: l ) 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 ( 1 03 PREMIUM ( ) 04 DIESEL f 1 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1/4 ( 7 GAUGE (X) 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 ( ] 03 LINED <br /> D. (X) 01 CARBON STEEL ( ] 02 STAINLESS STEEL ( ) 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( 1 08 BRONZE ( ] 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> 0 <br />