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•\V\�� �� STATE ID NUMBER 00000056666004 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> (X1 .01 NEW PERMIT f 1 05 RENEWED PERMIT X) 07 TANK CLOSED ( 1 09 DELETE FROM FILE (NO FEE) <br /> lel 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( 1 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIGUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> STEVEN J. 01 FED ( 1 02 STATE ( 1 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 321 NORTH CALIFORNIA ST. LOOI CA 95240 <br /> II FACILITY <br /> FACILITY NA / DEALER/FOREM,AN/SUPERVISOR <br /> STREET ADDRESS NEAREST 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 /> PHONE W/APPA C _ TYPE OF BUSINESS <br /> (X) 01 GASOLINE STATION ( 1 02 OTHER <br /> NUMBER OF CONTAINERS RURAL 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 /> �$ 209-366-4765• 7 Once, <br /> E THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 4 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> 0. CONTAINER CAPACITY: 6000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( ] 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES f 1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> 01 UNLEADED ( ) 02 REGULAR (v 0 P ( 1 04 DIESEL f 1 05 WASTE OIL 6W-T-06 OTHER UNKNOWN <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( l GAUGE f 1 INCHES ( ) CM (X) UNKNOWN <br /> B. ( 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) f 02 NON-VAULTED W.F 03 UNKNOWN <br /> C. f ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( ) 03 LINED <br /> D. ( ) 01 CARBON STEEL ( 7 02 STAINLESS STEEL ( 1 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE l ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE f 1 09 COMPOSITE f 1 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />