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• 1�1V,���� STATE ID NUMBER 00000056666003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT V07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT C ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPFOPATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLICAGENCY ONLY <br /> STEVEN J. C6T7'ROCS��' � f 1 O1 FED 1 7 02 STATE ( ] 03 LOCAL <br /> STF'_ET 40OPESS CITY STATE ZIP <br /> 321 NORTH CALIFORNIA ST. LODI CA 95240 <br /> II FACILITY <br /> FACILITY NAYS DEAIER/FOREMAN/SUP RVISOR <br /> btu-k n- iIBMYtD-TRf2Kf�i <br /> STREET ADDRESS NEAREST CROSS SIRE <br /> 305 WEST LODI AVE. <br /> CITY COUNTY <br /> 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 TYPEOF BUSINESS <br /> (X) 01 GASOLINE STATION ( ] 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 /> TomETTS—*eWtO 209-366'-4'/fs- � TRiemtEf r-RoA"oL 209-334eD3SC �� <br /> UUM <br /> PLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER #1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> 0. CONTAINER CAPACITY: 6000 GALLONS f ) UNKNOWN E. DOES THE CONTAINER STORE: f ) 01 WASTE (XI 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 /> (X) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> 0 <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ! 1 INCHES f i CM (X) UNKNOWN <br /> B. f 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) 02 NON-VAULTED 6y4- 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED f 1 03 LINED <br /> D. ( ) 01 CARBON STEEL f l 02 STAINLESS STEEL f l 03 FIBERGLASS f 1 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN [ ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />