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44K <br /> STATE ID NUMBER 00000014023003 <br /> APPLICATION FOR PERMIT TO OPERATE--- UNDERGROUND STORAGE TANK <br /> ( ) <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( l GAJ T u CLQsEn <br /> ( 1 02 CONDITIONAL PERMIT f ) 06 AMENDED PERMIT 1�f" 08 MINOR C-HAN_GE(NO SURCHARGE) 09 DELETE FROM FILE (NO FEE) <br /> I OWNER <br /> NAME(COPPOPATION,INDIVIDUAL OR PUBLIC AGENCYI PUBLIC AGENCY ONLY <br /> ERNIE'S SEPTIC TANK CO. INC. f ) 01 FED ( ) 02 STATE ( 03 LOCAL <br /> STREET ADDRESS CITY STATE IIP <br /> 25409'N HWY 99 ACAMPO CA 95220 <br /> II FACILITY <br /> FACILITY NAM! DEALER/FOREMAN/SUPERVISOR <br /> ERNIE'S SEPTIC TANK CO. INC. <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 25409 N HWY 99 COLLIER RD <br /> CITY COUNTY ZIP <br /> ACAMPO SAN JOAQUIN 95220 <br /> MAILING ADDRESS QCITY STATE ZIP <br /> Gv CA J, <br /> PHONE W/.4RE ODE TYPE OF BUSINESS <br /> 209- F2�D 01 GASOLINE STATION (X) 02 OTHER SEPTIC TANK CO <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTZON <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAMEf LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> ROBERGE ERNEST D. ZU ? -C"—L_) ROBERGE ERNEST D. - _S` R cc -- <br /> ROME <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: O <br /> CONTAINER NUMBEkP-11- <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> 0. CONTAINER CAPACITY: 4000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 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 (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL f 1 05 WASTE OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X1 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL f ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE t ) 05 CONCRETE <br /> t ) 06 ALUMINUM ( ) 07 STEEL CLAD f 1 08 BRONZE ( ) 09 COMPOSITE f ) 10 NON-METALLIC <br /> f ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) <br /> PAGE 1 <br /> 9 <br />