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STATE ID NUMBER 00000056666005 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> (0 01 NEW PERMIT ( ) 05 RENEWED PERMIT ) 07 TANK CLOSED f ) 09 DELETE FROM FILE (NO FEE) <br /> 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT 1 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAM'-(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> STEVEN J. eM TROtt ( 1 01 FED f ) 02 STATE ( ) 03 LOCAL <br /> STREET ADCPESS CITY ST.A TE ZIP <br /> 321 NORTH CALIFORNIA ST. LODI CA 95240 <br /> II FACILITY <br /> FACILITY NAS t DEALE RD EALER/F�OREMA N/SVPER � <br /> 5&FitRCVCIE <br /> STPEET 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/AREA CODE TYPE OF BUSINESS <br /> j69-�Y - (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/APEA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE_ W/AREA CODE <br /> 209- T.4Qif*T-T,-RGHftl9 209-a94-V53r a <br /> ETE THE FOLLOWING ON A SEPA ORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 5 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 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 ( ) 04 DIESEL (X) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( 1 CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( 02 NON-VAULTED +Htr 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED f ) 02 SINGLE WALLED ( 1 03 LINED <br /> D. ( ) 01 CARBON STEEL ( l 02 STAINLESS STEEL ( ] 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 1 07 STEEL CLAD f ) 08 BRONZE ( ) 09 COMPOSITE ( 1 10 NON-METALLIC <br /> (X) 12 UNKNOWN f ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> 0 0 <br />