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STATE ID NUMBER 00000014297001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> LjT 0 N� EW PERMIT f ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( l 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 IONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> GOEHRING MEAT INC. L ) 01 FED ( 1 .02 STATE 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 18846 N HY 99 LODI CA 95240 <br /> r <br /> II FACILITY <br /> FACILITY-NAME DEALER/FOREMAN/SUPERVISOR <br /> --�=" �= P �✓6 _ss -7 div L urxrn--Feer— oAJ Ns Qa cic <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 18846 N. MY 99 CLARK RD. <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILIN3 ADDRESS CITY STATE ZIP <br /> P.O. BOX 147 LODI CA 95240 <br /> PHONE W/AP.E4 CODE TYPE OF BUSINESS <br /> 209-368-5117 ( l Ol GASOLINE STATION (X) 02 OTHER AGRI BUSINESS <br /> NUMBER OF ONT42NERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 4r 3 H7E 31 <br /> .. __ <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> GAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> 209-368-5117 - - <br /> t1n..,�./1aA,4 URS,,.. <br /> LLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( 1 04 OTHER: CONTAINERNUMBER 1 <br /> B. MANUFACTURER fIF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> 0. CONTAINER CAPACITY: 8000 GALLONS f ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? IX) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED (X) 02 REGULAR ( 1 03 PREMIUM ( ) 04 DIESEL l 1 05 WASTE OIL ( ) C6 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f ) GAUGE ( I INCHES ( ) CM (X) UNKNOWN <br /> B. ( 7 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( 7 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> 0. (X) 01 CARBON STEEL ( 1 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( 7 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 1 07 STEEL CLAD f ) 08 BRONZE ( 1 09 COMPOSITE ( 1 10 NON-METALLIC <br /> ( 7 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/851 PAGE 1 <br /> i <br />