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`6' STATE ID NUMBER 00000000716005 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> f 7 <br /> 01 NEW PERMIT ( ) OS RENEWED PERMIT 07 TANK CLOSED 8'Y 09 DELETE FROM FILE (NO FEE) <br /> f 7 02 CONDITIONAL PERMIT ( ! 06 AMENDED PERMIT 1 08 MINOR CHANGE (NO SURCHARG i' <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> LODI METAL TECH., INC. ( 1 01 FED ( ) 02 STATE f 7 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 213 S. KELLY ST. LORI CA 95240 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOPEMAN/SUPERVISOR <br /> LODI METAL TECH., INC. ROBERT LIND <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 213 S. KELLY ST. LODI AVE. <br /> CITY COUNTY ZIP <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 OF6USI NE SS <br /> 209-334-2500 f 1 01 GASOLINE STATION (X) 02 OTHER MANUFACTURING <br /> NVMSER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 6 <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/ARCA 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 2 <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: C. YEAR INSTALLED 1974 ( 1 UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: f ) 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 /> ( ] <br /> 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL f l OS WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE f ) INCHES ( ) CM (X) 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. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 1 07 STEEL CLAD ( l 08 BRONZE 1 ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: / <br /> . HSC04-070185 (10/18/85) PAGE 1 / <br />