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JIwo, <br /> STATE ID NUMBER 00000017822006 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> f ) <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> f 1 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC ADEN Y) PUBLIC AGENCY ONLY <br /> SCOiP-RAHGM-i . / LO r _T f 1 Ol FED ( ) 02 STATE ( 1 03 LOCAL <br /> STREET ADDRESS / CITY STATE ZIP <br /> 184"-N. A`T'K -RB. I g' 1/1 � I 0 A(�'e , LOCKEFORD CA 95237 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> KEN SCOTT <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 18401 N. ATKINS R0. BRANDT RD. <br /> CITY COUNTY ZIP <br /> LOCKEFORD SAN JOAQUIN 95237 <br /> MAILING ADDRESS CITY STATE ZIP <br /> P.O. BOX 476 LOCKEFORD CA 95237 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-727-5243 ( ) 01 GASOLINE STATION (X) 02 OTHER RANCH <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 6 4N 8E 33 <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/AREA CODE <br /> SCOTT, KENT 209-727-5243 I SAME - <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 6-WEB <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1974 C. YEAR INSTALLED 1974 l 7 UNKNOWN <br /> D. CONTAINER CAPACITY: GALLONS IXI UNKNOWN E. DOES THE CONTAINER STORE: (X) 01 WASTE ( ) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES (X) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> f ) <br /> 01 UNLEADED l ) 02 REGULAR ( ) 03 PREMIUM t ) 04 DIESEL f 105 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f 1 GAUGE ( 1 INCHES ( ) CM (X) UNKNOWN <br /> S. f 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( 7 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( ) 03 LINED <br /> D. f 1 01 CARBON STEEL ( 1 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE (X) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD f 1 08 BRONZE f 1 09 COMPOSITE f ) 10 NON-METALLIC <br /> ( 1 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />