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J Vim' "o STATE ID NUMBER 00000065605001 <br /> APPLICATION FOR PERMIT TO OP ATE DERGROUND STORAGE TANK <br /> (A 01 NEW PERMIT ( ) 05 REWENED PERMIT 07 TANK CLOSE ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> MONIER ROOF TILE COMPANY I( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESSCITY STATE ZIP <br /> 9508 HARLAN RD FRENCH CAMP CA 95231 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> MONIER ROOF TILE COMPANY <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 9508 HARLAN RD. MATHEWS <br /> CITY COUNTY ZIP <br /> FRENCH CAMP SAN JOAQUIN 95231 <br /> MAILING ADDRESS CITY STATE ZIP <br /> PO BOX 6037 STOCKTON CA 95205 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-982-1473 ( ) 01 GASOLINE STATION (X) 02 OTHER CONCRETE ROOF TILE M <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/ARCA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> JARAMILLO. DONALD 209-461-9215 SAME - <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. tX) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 1 <br /> S. MANUFACTURER (IF APPROPRIATE): YEAR MFG= C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 GALLONS ( I UNKNOWN E. DOES THE CONTAINER STORE= ( ) 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 /> (X) 01 UNLEADED ( ) 02 REGULAR ( 103 PREMIUM ( ) 04 DIESEL 1 ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( 1 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 l ) 03 LINED <br /> D. ( ) 01 CARBON STEEL [ 1 02 STAINLESS STEEL [ ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) OS CONCRETE <br /> ( ) 06 ALUMINUM [ ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( 1 10 NON-METALLIC <br /> (XI 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (05/05/86) PAGE 1 <br /> r <br /> "ftw i✓ *40f r <br />