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\w STATE ID NUMBER 00000035491002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> `7t' O1 NEN PERMIT f 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED l ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( 7 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CCRPCPATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> ALDERS SERVICE ( ) 01 FED f ] 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESSCITY STATE ZIP <br /> P.O. BOX 98 FARMINGTON CA 95230 <br /> II FACILITY <br /> FACILITY NAME OE LCR/FOREMAN/SUPERVISOR <br /> ALDERS SERVICE <br /> STREET ADDRESS NEAREST CROSS STREET <br /> P.O. BOX 98 <br /> CITY COUNTY ZIP <br /> FARMINGTON SAN JOAQUIN 95230 <br /> MAILING AODPESS CITY STATE ZIP <br /> P.O. BOX 98 FARMINGTON CA 95230 <br /> PHONE W/AREA CODE TYPE OF BUSINSS <br /> 209-886-5315 f 1 01 GASOLINE STATION (X) 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 2 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME( AST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NaMg(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> ALDERS 209-886-5315 ALDERS I/j'- 209-886-5462 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 2 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1935 f ) UNKNOWN <br /> D. CONTAINER CAPACITY: 600 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE fX) 02 PRODUCT <br /> F. D S THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X).01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> O1 UNLEADED f ) 02 REGULAR F .) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( 1 CM (X) UNKNOWN <br /> B. ( 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED f 1 03 LINED <br /> D. (X) 01 CARBON STEEL l ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ] 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( 1 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( ] 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> VOW <br />