Laserfiche WebLink
• /�a/� , �-.49 4 STATE IO NUMBER 00000065161002 <br /> APPLICATION FOR PERMIT TO O/POERATE UNDERGROUND STORAGE TANK <br /> 1 NEW PERMIT 1 ) 05 RENEWED PERMIT ' 07 TAMC rLOSPn . 09 DELETE FROM FILE (NO FEE) <br /> 02 CONDITIONAL PERMIT ( l 06 AMENDED PERMIT ( 1 Uo .a.urt ­..+bE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION.!I�ND1IVIDUAL OR PUBLIC AGENCY)Q � � � PUBLIC AGENCY ONLY <br /> MIQM mtSA <br /> " Y W. _ (j(s�( �"� ( ) 01 FED ( 1 02 STATE f ) 03 LOCAL <br /> STREET ADDRESS —J CITY <br /> . . i ✓ STATE ZIP J31>? <br /> 420- gE <br /> CA 95240' <br /> II FACILITY <br /> FACILITY NAME DEALER! ONEM /SUPERVISOR <br /> TOKAY SHELL <br /> STREET ADDRESS l4iiPEST CROSS STREET <br /> 420 W. KETTLEMAN LANE <br /> CITY COUNTY - ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESS CITYSTATE ZIP <br /> 420 W. KETTLEMAN LANE LODI CA 95240 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-334-0568 (X) 01 GASOLINE STATION 1 ) 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 4 <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 /> MIKE GALLOWAY 209-334-0568 GALLOWAY, MIKE 209-578-0169 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TAM( ( ) 04 OTHER: CONTAINER NUMBER 4 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 550 GALLONS ( ) 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 /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( 1 04 DIESEL (X) 05 WASTE OIL ( ] 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ! GAUGE ( 1 INCHES ( ) CM (X) UNKNOWN <br /> B. f ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( l 03 LINED <br /> D. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL [ ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE l ) 05 CONCRETE <br /> ( ) 06 ALUMINUM l ) 07 STEEL CLAD [ ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (05/05/86) PAGE 1 <br />