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STATE ID NUMBER 00000065254003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> f 101 NEW PERMIT f 105 RENEWED PERMIT 90 GT Teuv LLQu 1 ) 09 DELETE FROM FILE INO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT t ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CHEROKEE MEMORIAL PARK, INC. ( ) 01 FED ( ) 02 STATE I ) 03 LOCAL <br /> STREET ADDRESS CITY STAT! 2IP <br /> HIGHWAY 99 AT HARNEY LANE LORI 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 /> Op `G• �!rCr.Li'K BECKMAN R0. <br /> CITY COUNTY <br /> 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 TYPE OF BUSINESS <br /> 209-334—%13 ( ) 01 GASOLINE STATION (X) 02 OTHER MEMORIAL PARK <br /> NUMBER OF CONTAINERS RURAL 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 209-334-9613 IRWIN, J. CHARLES 209-334-9222 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TAM( ( ) 04 OTHER: CONTAINER NUMBER 3 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: GALLONS IX) UNKNOWN E. DOES THE CONTAINER STORE: t ) 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 /> 1X1 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM 1 ) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( 1 GAUGE I ) INCHES [ 1 CH (X) UNKNOWN <br /> B. ( 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) 1 ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. l ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( ) 03 LINED <br /> D. ( 1 01 CARBON STEEL ( 1 02 STAINLESS STEEL f ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE t 1 05 CONCRETE <br /> 1 ) 06 ALUMINUM l ) 07 STEEL CLAD ( 1 08 BRONZE [ ) 09 COMPOSITE 1 ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN t ) 13 OTHER: <br /> NSC04-070185 (05/05/86) PAGE 1 <br />