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•NW STATE ID NUMBER 00000039074002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( 1 01 NEW PERMIT f ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED (yo9 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT l 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHA <br /> I OWNER <br /> NAME(CORPORATION.INOIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> EAST-SIDE WINERY ( ) 01 FED ( 1 02 STATE ( 1 03 LOCAL <br /> STREET ADDRESS CITYSTATE ZIP <br /> 6100 E. HIGHWAY 12 LODI CA 95240 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/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/AP.EA CODE TYPE OF BUSINESS <br /> 209-369-4768 ( ) 01 GASOLINE STATION (X) 02 OTHER WINERY <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION. <br /> 4 <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/ARCA 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): UNKNOWN YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 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 ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL (X) 05 WASTE OIL ( l 06 OTHER <br /> V CONTAINER CONSTRUCTION 4 <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE f ) INCHES f 7 CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( l 02 SINGLE WALLED ( ) 03 LINED <br /> 0. ( ) 01 CARBON STEEL ( l 02 STAINLESS STEEL [ ) 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( 1 06 ALUMINUM f ) 07 STEEL CLAD ( ) 08 BRONZE ( l 09 COMPOSITE ( 1 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> Itm► �� <br />