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A • • STATE ID NUMBER 00000012866001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) 1 NEW PERMIT [ ) 05 RENEWED PERMIt ( 7 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 02 CONDITIONAL PERMIT ( l 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAMB(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> THIEMANN'S SERVICE ( ) 01 FED ( 1 02 STATE f 1 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 106 2ND ST RIPON CA 95366 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> THIEMANN'S SERVICE G.L. THIEMANN <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 106 2ND ST STOCKTON ST <br /> CITY COUNTY ZIP <br /> RIPON SAN JOAQUIN 95366 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 106 ST RIPON CA 95366 <br /> PHONE W/AREA CODE TYPEOF BUSINESS <br /> 209-599-3110 (X) 01 GASOLINE STATION 1 ) 02 OTHER <br /> NUMBED. OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 3 RIP <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 /> GL. THIEMANN 209-599-3110 G.L. THIEMANN 209-599-3158 <br /> COMPLETE THE FOLLOWING qt4, A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION . <br /> A. (X) 01 TANK ( 1 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1965 C. YEAR INSTALLED 1965 ( ) UNKNOWN <br /> 0. CONTAINER CAPACITY: 10000 GALLONS f ) UNKNOWN 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 /> f ) 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f ) GAUGE ( 1 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 ( 1 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL f 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE f l 05 CONCRETE <br /> f ) 06 ALUMINUM [ l 07 STEEL CLAD ( 1 08 BRONZE f ) 09 COMPOSITE f 1 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( 1 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />