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STATE ID NUMBER 00000003452004 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED <br /> F )) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( l 06 AMENDED PERMIT ( l 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> PUBLIC AGENCY ONLY <br /> NAME!CORPOPATICN.INDIVIOUAL OR PUBLIC AGENCY) ( ) O1 FED i ) 02 STATE ( 1 03 LOCAL <br /> 3B'S TRUCK & AUTO PLAZA E <br /> CITY STATE ZIP <br /> STREET ADDRESS LODI CA 95240 <br /> 14749 N. THORTON ROAD <br /> II FACILITY <br /> DEALER/FOREMAN/SUPERVISOR <br /> FACILITY NAME <br /> THREE 'B'S TEXACO <br /> NEAREST CROSS STREET <br /> STREET ADDRESS <br /> 14749 N. THORNTON RD <br /> COUNTY ZIP <br /> CITY SAN JOAQUIN 95240 <br /> LODI <br /> STAT: ZIP <br /> " LO GA <br /> SAILIN3 ADDRESS CITY 05240 <br /> 14749 N. THORNTON RD <br /> PHCNE W/AP.EA CCDE TYPE OF BUSINESS <br /> 209-443-0654 (X) 01 GASOLI <br /> NE- STATION ( ) 02 OTHER <br /> E RURAL APEAS ONLY WNSHIP RANGE SECTION <br /> NL"',BER OF CCNTAIN.PS <br /> 4 <br /> II1 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 /> PERSON IN CHARGE 209-943-0654 r..Sd '✓l <br /> c � `� + <br /> COMP)-LETE THE FOLLOWING ON A 'SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: <br /> CONTAINERNUMBER 4 <br /> B. MANUFACTURER (IF APPROFRIATE)= YEAR MFG C. YEAR INSTALLED [X) UNKNOWN <br /> D. CONTAINER CAPACITY: 12000 GALLONS i ) UNK�E. DOESCONTAINER STORE= ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CCNTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( 1 02 NO IF YES CHECK APPROPRIATE BOX(ES)= <br /> (X) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( 3 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( 1 GAUGE ( l INCHES ( I CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( 0 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( ) O1 DOUBLE WALLED 02 SINGLE WALLED ( 1 03 LINED <br /> D. (X) 01 CARBON STEEL ( 1 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( ] 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( l 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER= <br /> PAGE 1 <br /> HSC04-070185 (10/18/85) <br />