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STATE ID NUMBER 00000053281003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> (g) 01 NEW PERMIT ( ) 05 RENEWED PERMIT 4( ;07 TANK_ CLOSED (X1 09 DELETE FROM FILE (NO FEE) <br /> ( l 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT M FT R( CHA�NGE (NO SURCHARG <br /> I OWNER <br /> NAME(CORPORATION.INDIVIOUAL OR PUBLIC AGENCY) PUBLIf AGENCY ONLY <br /> ARTHUR, ROSSETTI ( ) O1 FED f ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 25411 E. LONE TREE RD. ESCA LON LA 95320 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> ROSSETTI'S SERVICE OWNER <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 25411 LONE TREE RD. <br /> CITY COUNTY Zip <br /> ESCALON SAN JOAQUIN 95320 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 25411 E. LONE TREE RD ESCALON CA 95320 <br /> PHONE W/APEA CODE TYPEOF BUSINESS <br /> 209-838-2896 (X) 01 GASOLINE STATION f 1 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECT20N <br /> 4 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NI CMTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> ROSSETTI, ARTHUR 209-838-2996 SAME - - <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK f 1 04 OTHER: CONTAINER NUMBER 4 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 2000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> P. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? fX) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( 1 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1/4 ( ) GAUGE (X) INCHES ( ) CM ( ) UNKNOWN .. <br /> B. ( 1 01 VAULTED (LOCATED IIN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> (i <br /> C. f ) 01 DOUBLE WALLED ) 02 SINGLE WALLED ( 1 03 LINED <br /> D. q) 01 CARBON STEEL (`': 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD f ) 08 BRONZE (X) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( 1 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE I <br />