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J <br /> STATE ID NUMBER 00000003367013 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> / 1 O1 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TAW CLOSED C'J 09 DELETE FROM FILE (NO FEE) <br /> ( 1 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> J.R. SIMPLOT COMPANY f l 01 FED ( 7 02 STATE ( 1 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 999 MAIN ST. (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 IIP <br /> LATHROP SAN JOAQUIN 95330 <br /> MAILING ADDRESS CITY STATE IIP <br /> P. 0. BOX 198 LATHROP CA 95330 <br /> PNO NC W/A4EA CCOE TYPE OF BUSINESS <br /> 209-858-2511 ( ) 01 GASOLINE STATION (X) 02 OTHER AG CHEM AND FER <br /> NUM9ER 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 NSOHTS: NAMEIlAST NAME FIRST) AND PHONE W/ARlA CODE <br /> EOSON, ROBERT N. 209-858-2511 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 124 <br /> S. MANUFACTURER (IF APPROPRIATEI: YEAR MFG: I C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 250 GALLONS f ) UNKNOWN E. DOES THE CONTAINER STORE: f ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? f ) 01 YES (X) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL f l 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 8 l ) GAUGE (X) INCHES ( ) CM ( I 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 ( 1 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ] 04 POLYVINYL CHLORIDE (XI 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD [ 1 08 BRONZE ( l 09 COMPOSITE ( ) 10 NON-METALLIC <br /> f ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE I <br />