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0 <br /> STATE ID NUMBER 00000011196003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> vW Yi 1 1 05 RENEWEDPERMIT1 1 07 TANK CLOSED f l 09 DELETE FROM FILE (NO FEE ) <br /> ( ) 02 CCUDITIONAL PERMIT ( ) 06 AMENDED PEPH17 1 1 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> N�:"I£(C_PPC%=T_04.iN7.v iDVAL OP PU91LIC AGENCY ? PUBLIC AGENCY ONLY <br /> E-Z SERVE, INC. f 1 O1 FED ( 3 02 STATE f ) 03 LOCAL <br /> S7P!E7 =OCPESS GITr STATE Z_P <br /> 9I O1 SOUTH 1ST. _ --- ---ssL - ABILENE TX 79602 - <br /> II FACILITY <br /> F.==iL=7Y N-r-E DEALEP/FOPEMAN,SUPERvISOP L� <br /> MADSEN'S SUNRISE DAIRY <br /> S-;EET A_DPESS NEAPES CROSS STREET <br /> 239 SOUTH STOCKTON <br /> CITY COUNTY Zip <br /> RIPON SAN JOAQUIN 45366 <br /> MAILZN3 ADD21SS CITY _ STATE ZIP <br /> P.O. BOX . I-94 04— tp <br /> PNONE. ...:.-:.PEA C-DE 71PE OF BUSINESS <br /> 43•G—b32=h4$L 3_715 (X) O1 GASOLINE STATION 1 l 02 OTHER <br /> NUMBEW OF CONTAINERS PUPAL APEAS ONLY TOWNSHIP RANGE SECTION <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NA,ME( LAST NAME FIRST) AND PHONC W/APER CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/APEA CDCE <br /> �kl` IfF45LEQ�ttaY 61A Off9= tr1-3733 <br /> 1 LP <br /> COMPLETE THE FOLLO B14tf�'( <br /> IV DESCRIPTION <br /> A. (X) 01 TANK f ) 04 OTHER: CONTAINER NUMBER 63 <br /> B. MANUFACTURER (IF APPROPRIATE): BAGWELL YEAR MFG: C. YEAR INSTALLED 78 ( ) UNKNOWN <br /> 0. CONTAINER CAPACITY: 6016 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE= f ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (XI 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES1: <br /> I ) 01 UNLEADED (X) 02 REGULAR ( 1 03 PREMIUM ( ) 04 DIESEL 1 1 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( D GAUGE ( 1 INCHES ( l CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED f ) 03 UNKNOWN <br /> C. f ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS I 1 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> 1 D 06 ALUMINUM ( 1 07 STEEL CLAD f l 08 BRONZE 1 ) 09 COMPOSITE ( 1 10 NON-METALLIC <br /> ( 1 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />