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/v 1? Pmo)e�a <br /> STATE ID NUMBER 00000060391003 <br /> APPLICATION FOR PERMIT TO OPER T_ GROUND STORAGE TANK <br /> ( ) 01 NEW PERMIT ( ) 05 RENEWED PERMIT ED f ] 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT 108 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CLAUDE C. WOOD COMPANY ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STPEET ADDRESS CITY STATE ZIP <br /> 686 E. LOCKEFORD LODI CA 95240 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> CLEMENTS ROCK PLANT JESS GAYLOR <br /> STF-c ET ADDRESS NEAREST CROSS STREET <br /> 17300 E. JAHNAT ROAD <br /> CITY COUNTY ZIP <br /> CLEMENTS SAN JOAfiUIN 95227 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 17300 E. JAHANT ROAD CLEMENTS CA 95227 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-759-3331 ( ) 01 GASOLINE STATION (X) 02 OTHER AGGREGATE PRODUCTION <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 3 <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 /> BOB WHITEMORE 209-334-0790 BOB WHITEMORE 209-727-5721 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. tX) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER a' <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 5000 GALLONS f 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 f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1/4 f ) GAUGE ( ) INCHES ( ) CM ( ) UNKNOWN <br /> S. t ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. f ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( 1 03 LINED <br /> D. (X) 01 CARBON STEEL f ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( 104 POLYVINYL CHLORIDE [ ] 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 1 07 STEEL CLAD ( 1 08 BRONZE f 1 09 COMPOSITE ( 1 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( 7 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />