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STATE ID NUMBER 00000049637002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> k�a_01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INOIVIDUAL OR PUBLIC AG_NCY) PUB LIC AGENCY ONLY <br /> nn��, ( ] 01 FED ( ) 02 STATE f ) 03 LOCAL <br /> STREET ADDRESS �� pp ++JJ CITY STATE ZIP <br /> BA DKEEJeN. V0..1Lenyjug <br /> LODI CA 95240 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> PLAZA LIQUORS t2BH--B*NE6{2 Toft s <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 /> PHONE W/AREA CODE TYPEOF BUSINESS <br /> 209-368-0127 (X) 01 GASOLINE STATION ( 7 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 3 <br /> ILI 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(L4TS? NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NA E T)FIRSAND PHONE W/AREA CODE <br /> ROF!"D'ANCER I�r11 Ci-fri4/�S _B � ZO -5�+7 ra Sal <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER A' <br /> B. MANUFACTURER (IF APPROPRIATE): PERKINS YEAR MFG: 78 C. YEAR INSTALLED 1978 ( 1 UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS f 1 UNKNOWN E. DOES THE CONTAINER STORE: f ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X1 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED f ) 02 REGULAR (X) 03 PREMIUM ( ) 04 DIESEL f 1 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1/4 ( ) GAUGE (X) INCHES ( ) CM ( ) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 0.2 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) Ol DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS f 1 04 POLYVINYL CHLORIDE f l 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 1 07 STEEL CLAD t ) 08 BRONZE l ) 09 COMPOSITE ( 1 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />