Laserfiche WebLink
0 • STATE ID NUrBER 00000009960002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> f ) 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( 1 02 CONDITIONAL PERMIT { 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLICAGENCY ONLY <br /> GEORGE GEMELLOS, I ( ) O1 FED ( 1 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 3049 W. HWY 12 LO4I CA 952409294 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> IDLEWILD MARKET SELF <br /> STPEET ADDR°SS NEAREST CROSS STREET <br /> 3049 W. HWY 12 DEVRIES RD. <br /> CITY COUNTY ZIP <br /> LOD1, SAN JOAQUIN 952409294 <br /> !.AILING ADDRESS ELO <br /> Y STATE ZIR <br /> SAME AS ABOVE I CA 952409294 <br /> PHONE W/.AREA CODE Tl PE OF BUSINESS <br /> 209-369-2057 t 01 GASOLINE STATION (X) 02 OTHER GROCERIES/GAS <br /> NUMBER OF COkTAINERS PURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> 2 3NO 6EA SOU <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> JAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: N.AME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> GEMELLOS, GEORGE 209-369-2057 SAME <br /> COMPLETE THE FOLLOWING ON A SEPARATE 'FORM FOR EACH CONTAINER <br /> IV DESCRIPTION -�- <br /> A. (X) 01 TANK f ] 04 OTHER- CONTAINER NUMBER #2 <br /> B. MANUFACTURER (IF APPROPRIATE) YEAR MFG, C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 550 GALLONS ( 1 UNKNOWNE. 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 i ) 02 REGULAR (X) 03 PREMIUM ( 1 04 DIESEL ( ) 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( 1 INCHES ( 1 CM (X1 UNKNCWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) C ) 02 NDN-VAULTED (X) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED f 1 02 SINGLE WALLED ( 1 03 LINED <br /> D. ( J 01 CARBON STEEL f ] 02 STAINLESS STEEL ( l 03 FIBERGLASS t ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM (X) 07 STEEL CLAD ( ] 08 BRONZE ( 109 COMPOSITE ( ) 10 NON-METALLIC <br /> f 1 12 UNKNOWN ( ) 13 OTHER: <br /> KSC04-070185 (10/18/85) PAGE I <br />