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f STATE IO NUMBER OOOOOpYR(MliB{ „C <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 1 1 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 /> NAM!(COPPORATION,INDIVIOUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> LODI IRON WORKS. INC. ( 1 01 FED f ) 02 STATE ( 1 03 LOCAL <br /> STREET ADDRESS CITY STATE IIP <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 J 1l,, HE REST CROSS STREET <br /> tO� ��T t �f2(7 5. 50.C.ramertFo ST. P K <br /> CITY t_ <br /> LORI -""-- COUNTY ZIP <br /> SAN JOAQUIN 95240 <br /> MAILING ADDRESS TY STATE IIP <br /> P.O. BOX 71 L DI CA 95240 <br /> PHONE W/APIA CODE TYPE OF BU INESS <br /> 209-366-5395 ( ) 01 GA CLINE S ON (X) 02 OTHER FOUNDRY <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY . T NS IP RANGE SECTION <br /> 3 <br /> III 24 HOUR EMERGENCY ONTA T PE SON <br /> DAYS: NAME(LAST NAME FIRST) AND ONE W/ARCA 0 NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> VAN STEENBERGE, KEVIN 209-368 95 VAN STEENBERGE, KEVIN 209-368-7240 <br /> COMPLETE THE FOL ING N A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 51 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 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 ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED (X) 02 REGULAR f 1 03 PREMIUM ( 1 04 DIESEL f 1 05 WASTE OIL t ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 12 (XI GAUGE ( ) INCHES ( 1 CM ( ) UNKNOWN <br /> B. ( 1 01 VAULTED )LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED 1 1 03 UNKNOWN <br /> C. f ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED f 103 LINED <br /> D. IXI 01 CARBON STEEL ( 1 02 STAINLESS STEEL f 1 03 FIBERGLASS 1 ) 04 POLYVINYL CHLORIDE f 1 05 CONCRETE <br /> 1 ) 06 ALUMINUM ( 1 07 STEEL CLAD l 1 08 BRONZE l 1 09 COMPOSITE 1 ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />