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C)_Ya-�r STATE ID NUMBER, 00000024871003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> f.�01 NEW PERMIT ( ) 05 RENEWED PERMIT M) 07 T�LOSED' ( 7 09 DELETE FROM FILE (NO FEE) <br /> 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) MINOR (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION.INDIVIDVAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> SAN JOAQUIN COUNTY MOSQUITO AB)4TP-M r ( ) 01 FED ( ) 02 STATE (J!A 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 200 N. BECKMAN ROAD LODI CA 95240 <br /> II FACILITY <br /> FACILITY NAME DEA LE /FOR EMAN/S PERVISOR <br /> SAN JOAQUIN COUNTY MOSQUITO ABA-TSf4jW7T rj3j <br /> STREET ADOPESS NEAREST CROSS STREET <br /> 200 N. BECKMAN ROAD E. PINE STREET <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESSCITY STATE ZIP <br /> S 3 5'xly' d- AIV L9B-P Sy�ucl�1LOY� CA 95-2 <br /> PHONE W/AREA CODE TYPEOF BUSINESS <br /> 209-368-5131 ( ) 01 GASOLINE STATION (X) 02 OTHER MOSQUITO ABATEMENT <br /> NUMBER. OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SCCTION <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/APEA CODE <br /> FIORI, JACK V. 209-982-4675 FI ORI. 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 7(03 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG C. YEAR INSTALLED 1970 ( ) UNKNOWN <br /> 0. CONTAINER CAPACITY: 7000 GALLONS ( ) 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 /> ( ) <br /> 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL f ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1/4 ( ) GAUGE (X) INCHES ( ) CM [ ) 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 ( ) 03 LINED <br /> D. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL f 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM (X) 07 STEEL CLAD f 1 06 BRONZE l ) 09 COMPOSITE f ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> `/ <br />