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STATE ID NUMBER 00000000716003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> f 1 <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT 07 TAMC CLOSED 09 DELETE FROM FILE (NO FEE) <br /> 1 1 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT (F ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPORATION.INDIVIDVAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> LODI METAL TECH., INC. ( ) <br /> 01 FED f ) 02 STATE f ) 03 LOCAL <br /> STREET ADDRESS <br /> 213 S. KELLY ST. CS TY STATE ZIP <br /> L001 CA 95240 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> LODI METAL TECH., INC. ROBERT LIND <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 213 S. KELLY ST. LODI AVE. <br /> CITY <br /> COUNTY IF <br /> LODI SAN JOAQUIN 95241 <br /> MAILING ADDRESS CITY STATE ZIP <br /> P. 0. BOX 558 LODI CA 95241 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-334-2500 ( l Ol GASOLINE STATION (Xl 02 OTHER MANUFACTURING <br /> NUMBER OF CONTAINERS RVRAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> 6 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS; NAMEfLAST NAME FIRST) AND PHONE W/A P.EA COC! NSOHTS: NAME(IAST NAME FIRST) AND PHONE W/AREA CODE <br /> GROSS, ALLEN 209-369-5245 GROSS, ALLEN 209-369-5245 <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)* UNKNOWN YEAR MFG: I C. YEAR INSTALLED 1974 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 12000 GALLONS ( ) 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 /> l ) <br /> 01 UNLEADED ( 1 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL f ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> D <br /> A. THICKNESS Of PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( 1 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. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( l 03 FIBERGLASS f l 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM f 1 07 STEEL CLAD ( 1 08 BRONZE [ ] 09 COMPOSITE l l 10 NON-METALLIC <br /> ( 1 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />