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STATE ID NUMBER 00000058262001 <br /> APPLICATION FOR PERMIT TO OPER E UNDERGROUND STORAGE TANK <br /> ( 01 NEW PERMIT ( ) 05 RENEWED PERMIT 1A-07 CLOSED 1 09 DELETE FROM FILE (NO FEE) <br /> (1 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT f ) 08 MINO�CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIOUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> WOODBRIDGE RURAL COUNTY FIRE P�B ( c l 1 01 FED ( ] 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE IIP <br /> 400 E. AUGUSTA STREET WOODBRIDGE CA 95258 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> WOODBRIDGE RURAL COUNTY FIRE ,P�aE1i�CE(7IOA( 1119-1-iEtf-1 LEONARD N. ORTIZ <br /> STPEET ACDPESS NEAREST CROSS STREET <br /> 400 E. AUGUSTA STREET <br /> CITY COUNTY ZIP <br /> WOODBRIDGE SAN JOAQUIN 95258 <br /> MAILING ADDRESS CITY STATE ZIP <br /> P.O. BOX 186 WOODBRIDGE CA 95258 <br /> PHONE W/AREA CODE TYPE OF BUSINSS <br /> 209-369-1945 ( ) 01 GASOLINE STATION (X) 02 OTHER FIRE DEPT. <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/yR EA CODE <br /> WOODBRIDGE FIRE DISTRICT 209-369-1945 SAME <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 01 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1958 C. YEAR INSTALLED 1958 ( l UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 GALLONS f ) UNKNOWN E. DOES THE CONTAINER STORE: f ) 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 /> ( ) <br /> 01 UNLEADED ( ) 02 REGULAR ( 1 03 PREMIUM (X) 04 DIESEL ( 1 05 WASTE OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> 0 <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 HON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( 1 03 LINED <br /> D. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS f l 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM f ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> . HSC04-070185 110/18/85) PAGE 1 <br /> *4/ amw <br />