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WEX STATE I0 NUMBER 00000024871002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> �L.Y1 NEW PERMIT ( ) 05 RENEWED PERMIT f'A_0 7,1&X CL 0 ( ) 09 DELETE FROM FILE (NO FEE) <br /> I ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR-CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CCRPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> SAN JOAQUIN COUNTY MOSQUITO ABATE 'C O�-S-F ( ) 01 FED ( ] 02 STATE 03 LOCAL <br /> STREET ADDRESS CITYSTATE ZIP <br /> 200 N. BECKMAN ROAD LOOI CA 95240 <br /> II FACILITY <br /> FACILITY NAME DEAL R/FOREMA /SUPERVISOR <br /> SAN JOAQUIN COUNTY MOSQUITO ABAT"FNr Q�yf 5 <br /> il <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 200 N. BECKMAN ROAD E. PINE STREET <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESS ' // CITY STATE ZIP <br /> SSO S, pir O/ l�� +*f- :5 CA95.20(0 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-368-5131 ( ) 01 GASOLINE STATION (X) 02 OTHER MOSQUITO ABATEMENT <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 3 <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 /> FIORI, JACK V. 209-982-4675 FIORI, JACK V. 209-368-9518 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER R02 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1968 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 6500 GALLONS ( l UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES (X) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> f ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1/4 f ) GAUGE (X) INCHES f ) CM ( 1 UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( 1 03 LINED <br /> 0. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS 1 l 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM (X) 07 STEEL CLAD f 1 08 BRONZE ( ) 09 COMPOSITE ( 1 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070165 (10/18/85) PAGE 1 <br />