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..i STATE ID NUMBER 00000017822005 CONTAINER CONSTRUCTION E. ( l 01 RUBBER LINED ( ) 02 ALKYD LINING ( 7 03 EPDXY LINING ( ) 04 PHENOLIC LINING ( ) 05 GLASS LINING ( ) 07 UNLINED (X) 08 UNKNOWN ( ) 09 OTHER: F. 1 1 01 POLYETHLENE WRAP ( ) 02 VINYL WRAPPING ( ) 03 CATHODIC PROTECTION (X) 04 UNKNOWN ( 1 05 NONE ( ) 06 TAR OR ASPHALT ( ) 09 OTHER: VI PIPING A. ABOVEGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY (CHECK APPROPRIATE BOXES) ( ) 04 PRESSURE ( ) 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE B. UNDERGROUND PIPING: f ) 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY (CHECK APPROPRIATE BOXES) ( ) 04 PRESSURE 1 ) 05 SUCTION f ) 06 UNKNOWN ( ) 07 NONE VII LEAK DETECTION ( ) O1 VISUAL ( ) 02 STOCK INVENTORY ( ) 04 VAPOR SNIFF WELLS ( 1 05 SENSOR INSTRUMENT f 1 Ob GROUND WATER MONITORING WELLS ( ) 07 PRESSURE TEST (X) 09 NONE ( ) 10 OTHER: VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS IF YOU CHECKED YES TO IV-F YOU ARE NOT REQUIRED TO COMPLETE THIS SECTION CURRENTLY PREVIOUSLY DELETE CASE[ (IF KNOWN) CHEMICAL (00 NOT USE COMMERCIAL NAME) STORED STOPED ( ) 01 ( ) 02 ( ) 03 ( l 01 ( ) 02 ( 1 03 ( ) 01 ( ) 02 ( ) 03 ( ) 01 ( ) 02 ( ) 03 ( 1 01 ( ) 02 ( ) 03 l 1 01 ( ) 02 ( ) 03 f 1 al ( ) 02 ( ) 03 ( ) 01 ( ) 02 ( ) 03 f l 01 ( ) 02 ( ) 03 - ( ) 01 ( ) 02 ( ) 03 ■ CHECK STATE WARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS IS CONTAINER LOCATED ON AN AGRICULTURAL FARM? (X) 01 YES / ) 02 NO THIS FORM HAS BEEN COMPLETED UNDER THE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. PERSON FILING (SIGNATURE) PHONE W/AREA CODE FOR LOCAL AGENCY USE ONLY ADMINISTRATING AGENCY CITY CODE COUNTY CODE CONTACT PERSON PHONE W/AREA CODE DATE OF LAST INSPECTION IN COMPLIANCE PERMIT APPROVAL DATE TRANSACTION DATE LOCAL PERMIT ID II ( ) 01 YES I ) 02 NO PAGE 2 HSC04-070185 (10/18/85) APPLICATION FOR �../ 1 ) Ol NEW PERMIT R PERMIT TO OPERATE STARE ID NUMBER 00000017822004 ( 1 02 CONDITIONAL PERMIT ( ) 05 RENEWED PERMIT UNDERGROUND STORAGE TANK ( 1 O6 AMENDED PERMIT ( 7 08 MINOR 07 TAW CLOSED (NO SURCHARGE)) 09 DELETE FROM FILE (NO FEE) I OWNER NAME(COP PORATION,I NO IVIOUA L OR PUBLIC AGENCY) SCOTT RANCH INC. PUBLIC AGENCY ONLY STREET ADDRESS f ) 01 FED f ) 02 STATE ( ) 03 LOCAL 18401 N. ATKINS RD. CITY LOCKEFORD STATE LIP CA 95237 II FACILITY [KEN ACILITY NAME SCOTT DEALER/FOREMAN/SUPERVISOR REET ADDRESSNEAREST CROSS STREW401 N. ATKINS RD. BRANDT RD. TY COUNTY LIP CKEFORD SAN JOAQUIN 95237 MAILING ADDRESS - CITY STATE ZIP P.O. BOX 476 LOCKEFORO CA 95237 PHONE W/APEA CODE TYPE OF BUSINESS 209-727-5243 ( ) 01 GASOLINE STATION (X) 02 OTHER RANCH NUMBER Of CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION 6 4N 8E 33 III 24 HOUR EMERGENCY CONTACT PERSON DAYS: NAME(LAST NAME FIRST) AND PHONE W/APEA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA COD! SCOTT, KENT 209-727-5243 SAME - COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER IV DESCRIPTION A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 4-CR B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1983 C. YEAR INSTALLED 1983 ( 1 UNKNOWN 0. CONTAINER CAPACITY: GALLONS (X) UNKNOWN E. DOES THE CONTAINER STORE: (X) 01 WASTE ( l 02 PRODUCT F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES (X) 02 NO IF YES CHECK APPROPRIATE BOX(ES): ( ) O1 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( l 05 WASTE OIL ( ) 06 OTHER V CONTAINER CONSTRUCTION A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( 1 INCHES ( 1 CM (X) UNKNOWN O1 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED (X) 03 UNKNOWN C. l l 01 DOUBLE WALLED [ ) 02 SINGLE WALLED ( 1 03 LINED D. ( )(0) CARBON LLUMINUML STAINLESS STEEL 03 BRONZEF IBERG09SCOMPOSITE POLYVINYL NoHHMETAILIC(X) 05 CONCRETE ( 1 12 UNKNOWN ( ) 13 OTHER: PAGE 1 HSC04-070185 (10/18/85)