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`01 *4mp4 STATE ID NUMBER 00000058162003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> t 01 NEW PERMIT ( 1 05 RENEWED PERMIT 00 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( l 02 CONDITIONAL PERMIT ( l 06 AMENDED PERMIT ( 1 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPORATION.INDIVIOUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> LODI UNIFIED SCHOOL DISTRICT ( 1 01 FED ( ) 02 STATE f>Q 03 LOCAL <br /> STREET ADDRESSCITY STATE ZIP <br /> 815 WEST LOCKEFORD ST. LODI CA 95240 <br /> II FACILITY <br /> , C y� <br /> FACILITY NAME L✓IN D- DEALER/FOREMAN/SUPERyISOR ��//,� .'/I <br /> MAINTENANCE & OPERATIONS YARD LEN FISCHER., dfre eJlor- m"f n. a V-Qperakow <br /> STREET ADDPESS NEAREST CROSS STREET <br /> 31 NORTH PACIFIC AVE. ELM STREET <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDPESS r CITY STATE ZIP <br /> LODI CA 95240 <br /> PHONE W/RPEA CODE TYPE OF BUSINESS <br /> 209-369-1242 (EY 01 GASOLINE STATION (x) 02 OTHER Sr-ko o <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NA`IE(LAST NAME FIRST) AND PHONE W/APEA CODE NIGHTS: 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 ( ) 04 OTHER: CONTAINER NUMBER M & 0 G-1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1978 C. YEAR INSTALLED 1978 f I UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS ( ) UNKNOWN I 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 /> ( ) <br /> 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( 1 05 WASTE OIL f 106 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 (X) 02 SINGLE WALLED f ) 03 LINED <br /> D. (X) 01 CARBON STEEL f ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM f 1 07 STEEL CLAD ( 1 08 BRONZE ( ] 09 COMPOSITE ( 1 30 NON-METALLIC <br /> f 1 12 UNKNOWN ( ) 13 OTHER: <br />• HSC04-070185 (10/18/85) PAGE 1 <br /> *Aw Ive <br />