Laserfiche WebLink
9 • STATE I0 NUMBER 00000059724002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 1 01 NEW PERMIT l 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 102 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION.INDIVIOUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> LODI CONCRETE PIPE SERVICE ( 1 01 FED ( 1 02 STATE ( 1 03 LOCAL <br /> STREET ADDRESS CITY STAT! ZIP <br /> 381 W. TADDEI RD. ACAMPO CA 95220 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/S PERVISOR I ,� <br /> HARRY LORZ r ✓Y/� v <br /> STP!ET ADDRESS NEAREST CROSS STREET <br /> 381 W. TADDEI RD. BENDER <br /> CITY COUNTY ZIP <br /> ACAMPO SAN JOAQUIN 95220 <br /> MAILING ADDRESS CITYSTAT! ZIP <br /> 381 W. TADOEI R0. ACAMPO CA 95220 <br /> PHONE W/ARCA CODE TYPE OF BUSINESS <br /> 209-369-3306 ( ) 01 GASOLINE STATION (X) 02 OTHER IRRIGATION <br /> NUM.BIR OF CONTAINERS PUPAL AREAS ONLY : TOWNSHIP RANO! SlOTION <br /> 2 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NA{1! FIRST) AN PHONE W/ARIA CODE <br /> Hf� 209-369-3306 SAME or7 ',Av rr( ' <br /> rz• <br /> �OMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. fX) 01 TANK ( 1 04 OTHER: CONTAINER NUMBER 2 <br /> B. MANUFACTURER IIF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 350 GALLONS ( 1 UNKNOWN E. DOES THE CONTAINER STORE: ( l 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( 1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> (XI 01 UNLEADED ( 1 02 REGULAR ( ) 03 PREMIUM f ) 04 DIESEL l ) 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION o <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1 I GAUGE f 1 INCHES l 1 CM (X) UNKNOWN <br /> B. ( 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) l J 02 NON-VAULTED 1 03 UNKNOWN <br /> C. f 1 01 DOUBLE WALLED 1 02 SINGLE WALLED l 1 03 LINED <br /> D., ( 1 01 CARBON STEEL f 1 02 STAINLESS STEEL 1 1 03 FIBERGLASS l 1 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( 108 BRONZE l 1 09 COMPOSITE 1 1 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />