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-� - s <br /> STATE ID NUMBER OBB(10964II82QQ1, <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( l O1 NEN PERMIT ( 1 05 RENEWED PERMIT (Ar 07 TANK CLOSED 9 DELETE FROM FILE (NO FEE) <br /> t I OY CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT 1 1 08 MINOR CHANGE (NO SURCHARG <br /> I OWNER <br /> NAME(COPPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> LODI IRON WORKS. INC. ( ) 01 FED ( l 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITYSTATE ZIP <br /> 1029 S. SCHOOL STREET LODI CA 95240 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> LODI IRON WORKS. INC. <br /> STREET ADDRESS _� �{ NEAR ST CROSS STREET <br /> Y'20 S. SCICf /we/l�o J), PA <br /> CITY -------- COUNTY ZIP <br /> LODI SAN J AOUIN 95240 <br /> MAILING ADDRESS CITY STATE ZIP <br /> P.O. BOX 71 LODI CA 95240 <br /> PHONE W/AREA CODE TYPEOF BUSINESS <br /> 209-368-5395 ( ) 01 GASOLINE S ATION (R, 02 OTHER FOUNDRY <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWN IP RANGE SECTION <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT ERSO <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/APEA DENIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> VAN STEENBERGE, KEVIN 209-368-5395 VAN STEENBERGE, KEVIN 209-368-7240 <br /> COMPLETE THE FOLLOWING 0A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X1 01 TANK ( ) 04 OTHER: CONTAINER NUMBER R2 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 500 GALLONS ( 1 UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE 1X1 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? 1X1 01 YES ( 1 02 NO IF YES CHECK APPROPRIATE BOXIEST: <br /> (X) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( 1 04 DIESEL ( 1 05 WASTE OIL f 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 12 (X) GAUGE f 1 INCHES ( ) CM l 1 UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED (X) 02 SINGLE WALLED f 103 LINED <br /> D. 1X1 01 CARBON STEEL l 1 02 STAINLESS STEEL ( ) 03 FIBERGLASS 1 1 04 POLYVINYL CHLORIDE I ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD 1 1 08 BRONZE ( ) 09 COMPOSITE ( 1 10 NON-METALLIC <br /> C ) 12 UNKNOWN ( ) 13 OTHER: <br /> SC04-070185 110/18/85) PAGE 1 <br /> 1 46 0 <br />