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APPLICATION FOR PERMIT <br /> STATE ID NUMBER 00000014297002 <br /> ET: <br /> TO OPERATE UNDERGROUND <br /> :Qw".u�wL.URMITCONOITIONAL PERMIT ( ) 05 RENEWED PERMIT STORAGE TANK <br /> ( ) 06 AMENDED PERMIT f ) 07 TANK CLOSED <br /> I <br /> OWNER ( ) 08 MINOR CHANGE (NO SURCHARGE)) 09 DELETE FROM FILE (NO FEE) <br /> NAME(COR POP ATION,INDIVIDUAL OR PUBLIC AGENCY) <br /> GOEHRING MEAT INC. <br /> STREET ADDRESS PUBLIC AGENCY ONLY <br /> 18846 N HY 99 ( ) O1 FEO ( ) 02 STATE <br /> CITY 3 LOCAL <br /> LODI STATE IIP <br /> I I <br /> FACILITY CA 95240 <br /> FACILITY NAME <br /> STREET ADDRESS rr�_- DEALER/FOREMAN/SUPERVISOR <br /> - I f"^1 r r <br /> 18846 N. Hy 99 _ - - !,� _�!/J <br /> NEAREST CROSS STREET <br /> CITY <br /> LODI CLARK RD. <br /> COUNTY <br /> MAILING ADDRESS SAN JOAQUIN ZIP <br /> P.O. BOX 147 CITY 95240 <br /> PHONE W/AREACODE LODI STATE ZIP 209-368-5117 TYPE OF BusINEss CA 95240 <br /> NUMBER OONTAIN S ( ) 01 GASOLINE STATION (X) 02 OTHER AGRI BUSINESS <br /> f <br /> RURAL AREAS ONLY : TOWNSHIP <br /> 'RANGE <br /> H7E SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON 31 <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> 209-368-5117 NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> )COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: <br /> CONTAINER NUMBER 2 <br /> B. MANUFACTURER (IF APPROPRIATE): <br /> YEAR MFG: C. YEAR INSTALLED <br /> (XI UNKNOWN <br /> 0. CONTAINER CAPACITY: 12000 GALLONS f ) UNKNOWN E. DOES THE CONTAINER STORE: <br /> DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? 0 E ( ) O1 WASTE ( PPROPRIATE BOX(ESI: <br /> 02 PRODUCT <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL ( 105 WASTE20Io ( ) 06 OTHER <br /> IF YES CHECK AP <br /> CONTAINER CONSTRUCTION <br /> � or PRIMARY CONTAINMENT: <br /> ( ) GAUGE ( 1 INCHES ( 7 CM (X) UNKNOWN <br /> f ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X1 02 NON-VAULTED ( ) 03 UNKNOWN <br /> ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> f <br /> ) 06 ALUMINUM ( ) STEEL CLAD ( ) 08 BRO <br /> 1) UNKNOWN 13 OTHER: NZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( ) ( ) <br /> 14-070185 (10/18/85) <br /> PAGE 1 <br /> 0 • <br />