Laserfiche WebLink
'���L� STATE ID NUMBER 00000056211001 <br /> APPLICATION FOR PERMIT TOO R EQQ UNDERGROUND STORAGE TANK <br /> Qd.Al NEW PERMIT ( ) 05 RENEWED PERMIT 1$247 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT f ) 06 AMENDED PERMIT INOR CHANGE (NO SURCHARGE] <br /> I OWNER <br /> NAME(COPPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> LIBERTY RURAL COUNTY FIRE PROTL L.T(p/\ ( ( ) 01 FED ( ) 02 STATE _ SX) 03 LOCAL <br /> STPEET ADDRESS CITY STATE ZIP <br /> 24124 N BRUELLA RD ACAMPO CA 95220 <br /> II FACILITY <br /> ,FACILITY NAME ` DEALER/FOREMAN/SUPERVISOR <br /> LIBERTY RURAL C UHI-i FIRE PReT• STAN SEIFERT - FIRE CHIEF <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 24124 N BRUELLA RD JAHANT <br /> CITY COUNTY ZIP <br /> ACAMPO SAN JOAQUIN 95220 <br /> MAILING ADDRESS CITYSTATE ZIP <br /> 24124 N BRUELLA RD ACAMPO CA 95220 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-368-0905 ( ) 01 GASOLENE STATION (X) 02 OTHER FIRE STATION <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 2 <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/APER CODE <br /> SEIFERT, STAN 209-36.8-84}0- g 3 _ 3.5 3& SEIFERT, STAN 209-36i-0434 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): PERKINS W€LDING WORKS YEAR MFG: 1982 C. YEAR INSTALLED 1982 l ) UNKNOWN <br /> 0. CONTAINER CAPACITY: 1000 GALLONS ( ) UNKNOWN I E. DOES THE CONTAINER STORE: f ) 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 /> ( ) 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM (X) 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. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL [ ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM [ ) 07 STEEL CLAD ( 1 08 BRONZE t ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( 1 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE I <br />