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• - • STATE IO NUMBER 00000014023001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> [ ) <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( s 07 Tk�w rLOS <br /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ) 0i+Mln..: LMANGL (NO SURCHARGE) nc DELETE FarNt FT4F run cec) <br /> I OWNER <br /> NAM'_(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) <br /> ERNIE'S SEPTIC TANK CO. INC. PUBLIC AGENCY ONLY <br /> ( ) 01 FED ( ) 02 STATE ) 03 LOCAL <br /> STPEET ADDRESS <br /> 25409 N HE 99 CITY STATE ZIP <br /> ACAMPO CA 95220 <br /> II FACILITY <br /> [ACAMPO <br /> ITY NAME <br /> 'S SEPTIC TANK CO. INC. DEALER/FOREMAN/SUPERVISOR <br /> T ADDRESS <br /> N HWY 99 NEAREST CROSS STREET <br /> COLLIER RO <br /> COUNTY ZIP <br /> SAN JOAQUIN 95220 <br /> MAILING ADDRESS <br /> 49 CITY �G J STATE ZIP <br /> � U ca <br /> PHONE W/ARE CODE / << 7ypE OF BUSINESS <br /> 209-38 92 ( ) 01 GASOLINE STATION (X) 02 OTHER SEPTIC TANK CO <br /> NUMBER OF CONTAINERS PUPAL AREAS ONLY : TOWNSHIP <br /> 3 RANGE SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FYRST) AND PHONE W/APEA CODE NIGHTS: NAME( <br /> ROBERGE ERNEST D. LAST NAME FIRST) AND PHONE W/ApEA CODE <br /> - - ROBERGE ERNEST D. <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER// <br /> B. MANUFACTURER (IF APPROPRIATE): PERKINS YEAR MFG: <br /> C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F.VQES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( 1 02 NO IF YES CHECK APPROPRIATE BOX(E5): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( 1 03 PREMIUM h') 04 DIESEL f ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> r <br /> NESS OF PRIMARY CONTAINMENT: f ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> CARBON STEEL ( ) 02 STAINLESS STEEL f 1 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE t ) 05 CONCRETE <br /> 06 ALUMINUM ( l 07 STEEL CLAD f ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (1.0/18/85) <br /> PAGE 1 <br /> 0 �. <br />