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nAO STATE ID NUMBER 00000010620001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( 1 01 NEW PERMIT l 1 05 RENEWED PERMIT (>4 07 TAM( CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 1 ) 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT l 1 0 GE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPCRATION.INOIVICUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> WESTERN METER SERVICE, INC ( 1 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITYSTATE 2IP <br /> 1551 E. EIGHT MILE RD LODI CA 95240 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> WESTERN METER SERVICE, INC ROLAN OLSON <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1551 E EIGHT MILE RD WEST LANE <br /> CITY COUNTY ZIP <br /> LODI SAN JOAgUIN 95240 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 1551 E EIGHT MILE RD LODI CA 95240 <br /> PHONE W/ARCA CODE TYPE OF BUSINESS <br /> 209-948-6124 ( ) 01 GASOLINE STATION (X) 02 OTHER CONTRACTOR <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/AREA CODE <br /> OLSON. ROBIN - - 209-948-0124 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 002 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1971 C. YEAR INSTALLED 1971 (0) UNKNOWN <br /> D. CONTAINER CAPACITY: GALLONS ( ) )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 /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL f ) 05 WASTE OIL (X) 06 OTHER SOLVENT <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 10 (X) GAUGE ( ) INCHES ( ) CM l 1 UNKNOWN <br /> B. 1 ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED (X) 02 SINGLE WALLED ! ) 03 LINED <br /> D. f 1 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ] 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE l ) 05 CONCRETE <br /> f ) 06 ALUMINUM f 1 07 STEEL CLAD 1 ) 08 BRONZE ( 1 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN (X) 13 OTHER: MILD STEEL i <br /> MSC04-070185 (10/18/85) PAGE 11 <br /> i <br />