Laserfiche WebLink
.........,.._._. STATE ID NUMBER 00000008231001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) <br /> 01 NEW PERMIT ( l 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT f 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> GEWEKE FORD ( ) 01 FED ( ) 02 STATE f 7 03 LOCAL <br /> STREET ADDRESSCITY STATE ZIP <br /> 1045 S. CHEROKEE LORI CA 95240 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/S FRVISOR <br /> GEWEKE R.V. CENTER OAR, fiP�- D N <br /> STREET ADDRESS NEAREST CROSS STREET -_ <br /> 248 E. KETTLEMAN CENTRAL <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN 95241 <br /> MAILING ADDRESSCITY STATE ZIP <br /> P.O. BOX-4"- Q LODI CA 95241 <br /> PHONE W/AREA CODE TYPE OF DVSINESS <br /> 209-369-4725 3W-(,"0 ( ) 01 GASOLINE STATION (XI 02 OTHER -WASTO-B3r <br /> NUMBER OF CONTAIWEkr_ RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 1 <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 /> GPWOYE 72 <br /> LA2 Y 209-36"75 WERNER, JEFF 75Y_991t5 91/.z 2 9 <br /> ../ <br /> COMPLETE <br /> THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER R2 <br /> B. MANUFACTURER (IF APPROPRIATE): MODESTO WELDING YEAR MFG: C. YEAR INSTALLED 76 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 GALLONS 1 1 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 SOX(ES): <br /> (X) 01 UNLEADED f ) 02 REGULAR ( ) 03 PREMIUM f ) 04 DIESEL 1 ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 10 (X) GAUGE f 1 INCHES ( ) CM ( ) UNKNOWN <br /> B. f ) 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 /> 0. (X) 01 CARBON STEEL [ 7 02 STAINLESS STEEL f ) 03 FIBERGLASS ( 7 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> 1 ) 06 ALUMINUM ( l 07 STEEL CLAD ( 1 08 BRONZE ( l 09 COMPOSITE ( ) 10 NON-METALLIC <br /> f 112 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />