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STATE ID NUMBER <br /> r`-- - APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 1 ,1.01 NEW PERMIT f ) 05 RENEWED PERMIT f 1 07 TANK CLOSED ( 1 09 DELETE' FROM FI <br /> ILE (NO FEE <br /> T)-02 COtIOITIONAL PERMIT f 1 06 AMENDED PERMIT 1 1 08 MINOR CHANGE (NO SURCHARGE) <br /> r OWNER <br /> NAM!(COPPORATION,INCIVIDUAL OR PUBLIC AO!NCYI PUBLIC AGENCY ONLY <br /> hu' 0/2-.-"-1 1 1 01 FED 1 1 02 STATE C ) 03 LOCAL <br /> STa_ET AC�Rl+S CITY <br /> STATE ZIP <br /> __yt GGGlYtS �i12- <br /> 11 <br /> II FACILITY <br /> M'ACILITr NA—,E AL <br /> STFEET ADDIESS =N C Al 4Ao <br /> _ EST CST S�f7 <br /> CITY COVN7r ZIR <br /> MAILING A DRESS CITY C STATE 7.1 r <br /> PMON! WIAPEA CODE TYPE OF BUSINESS <br /> 01 GASOLINE STATION (�02 OTHER <br /> NUI'BE• CF CONTAINEPS PUPAL AREAS ONLY : TOWNSHIP PANGS SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAMEfLAST NAME FIPST) AND PHONE W/APEA COD! 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 /> 01 TAtlK I 1 02 OTHER: CONTAINER NUMBER <br /> B. MANUFACTURER IF APPROPRIATE T: YEAR MFG- C. YEAR INSTALLED I"T 1 UNKNOWN <br /> 0. CONTAINER CAPACITY: /60 GALLONS I 1 LINICNOWN E, DOES THE CONTAINER STORE: [ 1 01 WASTE 1 ) 02 PRODUCT <br /> F. DOES THE CONTAIIIER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( 1 01 YES [ 1 02 NO IF YES CHECK APPROPRIATE BOXIEST: <br /> --1 1 01 UNLEADLO ( 1 02 REGULAR t ) 03 PREMIUM ) 04 DIESEL l 1 OS WASTE OIL 1 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PP.IMARY CONTAINM€NT: ( 1 GAUGE ( 1 INCHES f I CM l 1 UNKNOWN <br /> 13. 1101 VAULTED ILOCATED IN At1 UNOERGROUNO VAULT) l 1 02 NON-VAULTED 1 1 03 UNKNOWN <br /> FC. f 1 01 DOUBLE W%LLEO 1 SINGLE WALLED f 1 03 LINEO <br /> fD. I CAPBON STEEL 1 1 02 STAINLESS STEEL 1 1 03 F16ERGLASS ( 1 04 POLYVINYL CHLORIDE I 1 05 CONCRETE <br /> )III ( ) 06 ALUMINUM I 1 07 STEEL CLAD ( 1 08 BRONZE f 1 09 COMPOSITE 1 1 10 NON-METALLIC <br /> 1 1 12 U14KNOW14 ( 1 13 OTHER: <br /> PAGE 1 <br />