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STATE ID NUMBER 00000037606001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( 1 <br /> 01 NEW PERMIT ( 1 05 RENEWED PERMIT av 09 DELETE FROM FILE (NO FEE) <br /> 1 ) 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT r7)__08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CCPPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> E5CALON UNIFIED SCHOOL DISTRIC ( ) 01 FED f ) 02 STATE l ) 03 LOCAL <br /> STZEET ADDRESS CITYSTATE ZIP <br /> 1520 YOSEMITE AVENUE ESCLON CA 95320 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> COLLEGEVILLE SCHOOL RUSSELL ORTLOFF <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 6701 SOUTH JACK TONE ROAD MARIPOSA ROAD <br /> CITY COUNTY 2IP <br /> STOCKTON SAN JOAQUIN 95205 <br /> MA:L:N3 ADOPESS CITY STATE ZIP <br /> 1520 YOSEMITE AVENUE ESCALON CA 95320 <br /> PHONE W/APEA CODE - TYPE OF BUSINESS <br /> 209-838-3165 ( ) 01 GASOLINE STATION f 1 02 OTHER <br /> NUMBER CF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 1 <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 /> ORTLOFF, RUSSELL 209-838-3165 ORTLOFF, RUSSELL 209-838-7181 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 4 <br /> B. MANUFACTURER (IF APPROPRIATE): UNK YEAR MFG: C. YEAR INSTALLED f 1 UNKNOWN <br /> 0. CONTAINER CAPACITY: 500 GALLONS ( 1 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 /> f ) 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE l 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 ( 1 02 SINGLE WALLED ( ) 03 LINED <br /> 0. ( ) 01 CARBON STEEL l ) 02 STAINLESS STEEL f 1 03 FIBERGLASS l ) 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE f ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />