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.41?erno✓ed <br /> STATE ID NUMBER 00000059512002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> f 1 <br /> 01 NEW PERMIT ( 1 05 RENEWED PERMIT 4&L07 TANK CLOSED LW09 DELETE FROM FILE (NO FEE) <br /> t l 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( 8 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COP PORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> J.R. SIMPLOT COMPANY, INC. ( ) 01 FED f ) 02 STATE ( ) 03 LOCAL <br /> STREET ADOPESS CITYSTATE ZIP <br /> P.O. BOX 912 - 151 N. 3RD POCATELLO ID 83204 <br /> II FACILITY <br /> FACILITY NAME DEALER/FCREMAN/SUPERVISOR <br /> SIMPLOT SOILBUILDERS BULL CORELL <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 2929 W. HARNEY LN. DEVRIES RD. <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 2929 W. HARNEY LN. LODI CA 95240 <br /> PHCVE W/AREA CODE TYPEOF BUSINESS <br /> 209-369-1921 (X) 01 GASOLINE STATION f ) 02 OTHER <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/AREA CODE <br /> CORELL> BILL 209-369-1921 CORELL> BILL 209-727-5493 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 2 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1965 C. YEAR INSTALLED 1965 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 500 GALLONS ( ) UNKNOWN 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 BOXf ES): <br /> (X) 01 UNLEADED [ ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f ) GAUGE f ) INCHES ( ) CM (X) UNKNOWN <br /> B. f l 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X1 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( ) 03 LINED <br /> 0. f ) Ol CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> f ) 06 ALUMINUM ( ) 07 STEEL CLAD ( 1 08 BRONZE 1 ) 09 COMPOSITE f ) 10 NDN-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> \s' *MON <br />