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STATE ID NUMBER 00000059889002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ) 01 NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPOPATION,SNDSVIOUAI OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> GEWEKE FORD & R.V. ( 1 O1 FEE ( ) 02 STATE i ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> E28 E. KETTLEMAN LODI CA 95240 <br /> Tf- FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> GEWEKE FORD A R.V. BOB DEMBEK <br /> STREET ADDRESS NURE%f C�Ry�S STREET <br /> E. KETTLEMAN <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESS CITY STATE ZIP <br /> P.O. BOX 1210 LODI CA 95241 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 2092 -650 ( ) 01 GASOLINE STATION (X) 02 OTHER R.Y. DEALER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 2 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODENIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> MARK GEWEKE 209368-8214 <br /> COMPLETE T ; FOLLOW NG ON A SEPARATE FORM FOR EACH CONTAIN _R <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: "_50 GALLONS lXl UNKNOWN E. DOES THE CONTAINER STORE: (X) 01 WASTE ( ) 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 f ) 02 REGULAR f l 03 PREMIUM ( ) 04 DIESEL (X) 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> 0 <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f ) GAUGE ( ) INCHES 1 ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED (X1 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( ) 03 LINED <br /> D. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> ( ) 06 ALUMINUM f ) 07 STEEL CLAD ( l 08 BRONZE f ) 09 COMPOSITE l 1 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/83) PAGE 1 <br />