Laserfiche WebLink
STATE I0 NUMBER 00000065254001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> f 1 <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 1 ) 02 CONDITIONAL PERMIT 1 ) 06 AMENDED PERMIT f ) 681ff R'EA7.APE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CHEROKEE MEMORIAL PARK. INC. I( ) 01 FED f 1 02 STATE f ) 03 LOCAL <br /> STREET ADDRESS CITYSTATE ZIP <br /> HIGHWAY 99 AT HARNEY LANE LODI CA 95240 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> CHEROKEE MEMORIAL PARK, INC. J. CHARLES IRWIN <br /> STREET ADDRESS NEAREST CROSS STREET <br /> aa�s c BECKMAN RD. <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESS CITY STATE ZIP <br /> P.O. BOX 1000 LODI CA 95241 <br /> PHONE W/AREA CODE TYPEOF BUSINESS <br /> 209-334-%13 ( 1 01 GASOLINE STATION (X) 02 OTHER MEMORIAL PARK <br /> NUMBER OF CONTAINERS AURAL AREAS ONLY TOWNSHIP RANGE SECTION <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 /> IRWIN. J. CHARLES 209-334-%13 IRWIN. J. CHARLES 209-334-9222 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER I <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1980 ( ) 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 ? IX) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> 1 ) 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: l ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( 1 02 NON—VAULTED (X) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED l ) 03 LINED <br /> D. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE 1 ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 107 STEEL CLAD ( l 08 BRONZE f l 09 COMPOSITE ( ) 10 )ION—METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (05/05/86) PAGE 1 <br /> L � <br />