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*400 STATE 10 NUMBER 00000058162002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> fkf'01 NEW PERMIT f 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( l 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> LODI UNIFIED SCHOOL DISTRICT ( ) 01 FED ( ) 02 STATE (A-r03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 815 WEST LOCKEFORD ST. LODI CA 95240 <br /> II FACILITY <br /> FACILITY NAMES DEALER/FOREMAN/SUPERVISOR.L� <br /> MAINTENANCE & OPERATIONS YARD LEN FISCHER, OlIY.0 V o`- MW 4eKQMc fe Vt OX .a <br /> STREET ACCPESS NEAREST CROSS STREET <br /> 31 NORTH PACIFIC AVE. ELM STREET <br /> CITU <br /> COUNTY ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 31 NORTH PACIFIC AVE. LODI CA 95240 <br /> PHCNE W/ARSE-A CODE TYPE OF BUSINESS <br /> 209-369-1242 (AM 01 GASOLINE STATION (X) 02 OTHER SC.�IOd I <br /> NUMBER OF CC NTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/ARCA CODE NIGHT$: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> FISCHER, LEONARD 209-369-1242 FISCHER> LEONARD 209-333-1565 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( 1 04 OTHER: CONTAINER NUMBER M & 0 0-1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1958 C. YEAR INSTALLED 1958 ( ) UNKNOWN <br /> 0. CONTAINER CAPACITY: 10000 GALLONS ( 1 UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X1 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( 1 02 NO IF YES CHECK APPROPRIATE SOX(ES): <br /> [ 1 <br /> 01 UNLEADED t ) 02 REGULAR ( 1 03 PREMIUM (XI 04 DIESEL f ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> S. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X1 02 SINGLE WALLED ( 1 03 LINED <br /> D. (X) 01 CARBON STEEL f ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS [ ) 04 POLYVINYL CHLORIDE f 1 05 CONCRETE <br /> ( ) 06 ALUMINUM f ) 07 STEEL CLAD [ 1 08 BRONZE ( 1 09 COMPOSITE ( 1 10 NON-METALLIC <br /> t 1 12 UNKNOWN ( ) 13 OTHER: <br />. HSC04-070185 (10/18/85) PAGE 1 <br /> t <br />