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• • STATE IO NUMBER 00000065722001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> f 1 <br /> 01 NEW PERMIT ( / 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( 1 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> WICKES COMPANIES. INC. ( ) O1 FED l ) 02 STATE l ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 3340 OCEAN PARK BOULEVARD SANTA MONICA CA 90405 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> FORMER LUMBER DISTRIBUTION CEN NONE <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1240 E. PINE STREET CLUFF AVENUE <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESSCITY STATE ZIP <br /> 2162 MICHELSON DRIVE IRVINE CA 92715 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 714-476-0808 ( 1 01 GASOLINE STATION ( 102 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> 1 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> NEWELL. DOUGLAS E. 714-476-0808 NEWELL, DOUGLAS 714-476-1478 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (XI 01 TANK l 1 04 OTHER: CONTAINER NUMBER 01 <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS ( 1 UNKNOWN E. DOES THE CONTAINER STORE: ( 1 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( 102 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL ( ) 05 WASTE OIL t 106 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: [ 1 GAUGE ( l INCHES l 7 CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( 1 02 SINGLE WALLED ( 7 03 LINED <br /> D. f 1 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE [ l 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( l 09 COMPOSITE ( ) 10 NON-METALLIC <br /> IX) 12 UNKNOWN ( ) 13 OTHER: <br /> NSC04-070185 (05/05/86) PAGE 1 <br />