Laserfiche WebLink
N.. ..i <br /> STATE ID NUMBER 00000003367011 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> I ) 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED09 DELETE FROM FILE (N0 FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGi) <br /> I OWNER <br /> NAME(CCRPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> J.R. SIMPLOT COMPANY ( ) 01 FED f ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS <br /> CITY STATE ZIP <br /> 999 MAIN 3T, (ONE CAPITAL CENT BOISE ID 83707 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> J.R. SIMPLOT COMPANY (LATHROP <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 16777 S. HOWLAND ROAD LOUISE AVENUE <br /> CITY COUNTY ZIP <br /> LATHROP SAN JOAQUIN 95330 <br /> CITY <br /> STATE ZIP <br /> P. 0. BOX 198 LATHROP CA 95330 <br /> MAILING ADDRESS <br /> PNONE W/AREA CODE TYPE OF BUSINESS <br /> 209-858-2511 f 1 01 GASOLINE STATION (X) 02 OTHER AS CHEM AND PER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> 37 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W✓AREA CODE NIONTS: NAME(LAST NAM! FIRSTI AND PHONE W/ARlA CODE <br /> EDSON, ROBERT W. 209-658-2511 EDSON, ROBERT W. 209-477-9780 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. f ) 01 TANK (X) 04 OTHER: SUMP CONTAINER NUMBER 122 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR IN (X) UNKNOWN <br /> 0. CONTAINER CAPACITY: 700 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: (X) 01 WASTE [ ) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES (X) 02 NO IF YES CHECK APPROPRIATE BOXIEST: <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: ( ) GAUGE t ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( 7 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( 102 SINGLE WALLED (X) 03 LINED <br /> D. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE (X) 05 CONCRETE <br /> f ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE l 1 09 COMPOSITE f 1 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />