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• ��`�'���� STATE ID NUMBER 00000056666001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> (,LS 01 NEW PERMIT ( 1 05 RENEWED PERMIT 7 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> l 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPORATIONrIPUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> STEVEN J. CS+;RBtNDIVZ UAL ORt ( ) 01 FED ( ) 02 STATE ( l 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 321 NORTH CALIFORNIA ST. LODI CA 95240 <br /> II FACILITY <br /> FACILITY NE DEALER/FOREMAN/SUPERVISOR <br /> 'SBS-ARe� '� <br /> STREET ADDRESS NEST CROSS STREET <br /> 305 WEST LODI AVE. <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 305 WEST LODI AVE. LODI CA 95240 <br /> P HONE W!.4 REA CODE TYPE OF BUSINESS <br /> (X1 01 GASOLINE STATION ( 7 02 OTHER <br /> NUMBER OF CONTAINERSRURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 5 <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 /> �A:=_, 209-3Qfi�#Mi3- � Z�, �BH*E9 2D9-334-BS38 6 a <br /> ToaLlw <br /> CO LETE THE FOLLOWING ON A SEPARA TAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 3 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> 0. CONTAINER CAPACITY: 4000 GALLONS (X) 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 /> ( 1 01 UNLEADED (X) 02 REGULAR ( 1 03 PREMIUM ( l 04 DIESEL f ) 05 WASTE OIL ( l 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( 1 INCHES ( 1 CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) W 02 NON-VAULTED Ht) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( 1 02 SINGLE WALLED ( 1 03 LINED <br /> D. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( 7 05 CONCRETE <br /> ( ) 06 ALUMINUM f 1 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE l ) 10 NON-METALLIC <br />` (X) 12 UNKNOWN ( ) 13 OTHER: <br /> V HSC04-070185 (10/18/85) PAGE 1 <br />