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%W 0(`moi b A <br /> ( '�W STATE ID NUMBER 00000039074007 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> l 1 01NEW NEW l 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED 9 DELETE FROM FILE (NO FEE) <br /> 1 l 02 CONDITIONAL PERMIT 1 ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHA 1 <br /> I OWNER <br /> NAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> EAST-SIDE WINERY l ) 01 FED ( ) 02 STATE 1 ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 6100 E. HIGHWAY 12 LODI CA 95240 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOPEMAN/SUPERVISOR <br /> EAST-SIDE WINERY LEE EICHELE <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 6100 E. HIGHWAY 12 CLUFF <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESS CITY STATE ZIP <br /> P.O. BOX 440 LODI CA 95241 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-369-4768 ( ) 01 GASOLINE STATION (X) 02 OTHER WINERY <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIPRANGE SECTION <br /> 8 <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 /> LEE EICHELE 209-369-4768 LEE EICHELE 209-369-4768 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 3 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 GALLONS (X) 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 /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL ( 1 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( 1 GAUGE [ 1 INCHES f 1 CM 1X1 UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( 1 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED 1 1 03 LINED <br /> D. ( ) 01 CARBON STEEL ( 1 02 STAINLESS STEEL ( 103 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE [ ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( 1 08 BRONZE f 1 09 COMPOSITE ( ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (05/05/86) PAGE 1 <br />