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- - STATE ID NUMBER 00000059889001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEEL <br /> 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPCRATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> GEWEKE FORD i R.V. <br /> ( 1 <br /> 01 FED [ ) 02 STATE f ) 03 LOCAL <br /> STREET ADDRESS <br /> CITY <br /> _F <br /> TAT[ IIP <br /> 226 E. KETT LEMAN LODI CA 95240 <br /> I FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> GE KE FORD 8 R.V. BOB DEMBEK <br /> TREE . ADDRESS NEAWE T C SS STREET <br /> E. KETTLEMAN �C� <br /> ' Y CO >UATY - ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESS CITY STATE iIP <br /> P.O. BOX 1210 LODI CA 95241 <br /> PHONE W/AREACODE TPEYOF BUSINESS <br /> 209- 49'E'r -r �5" ( ) <br /> � 01 GASOLINE STATION (X1 02 OTHER R.V. DEALER <br /> +� <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSXIP RANGE SECTION <br /> 2 <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 /> MARK GEWEKE 209-3p-m- 33Lf-�Ub GL. eA> EFC 9 -9Vr 2 <y <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER I <br /> B. MANUFACTURER (IF APPROPRIATE): STOCKTON SERVICE STATION EQUIP YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) Ol WASTE (X1 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 /> (X) <br /> OX(ES):(X) Ol UNLEADED [ ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( l 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f ) GAUGE f ) INCHES ( 7 CM (X) UNKNOWN <br /> B. f l 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) f ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( 7 02 SINGLE WALLED ( 1 03 LINED <br /> D. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( 7 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD f 1 08 BRONZE ( 1 09 COMPOSITE ( ] 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE I <br /> bw �� <br />