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STATE IO NUMBER 00000050198001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( 1 01 NEW PERMIT ( ) 05 RENEWED PERMIT [ 1 07 TANK CLOSED 09 DELETE FROM FILE (NO FEEL <br /> ( ] 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COP PCRATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> LUSTRE-CAL NAMEPLATE CORPORATI f 1 O1 FED f ) 02 STATE ( 1 03 LOCAL <br /> STREET ADDPESS - CITY STATE ZIP <br /> 110 E. TURNER RD. LODI CA 95240 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> LUSTRE-CAL NAMEPLATE CORPORATI JIM A. KERBS <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 110 E. TURNER RD. STOCKTON <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESS CITY STATE IIP <br /> P.O. BOX 439 - LODI CA 95240 <br /> PHONE W/ARCA CODE TYPE OF BUSINESS <br /> 209-334-6263 ( ) 01 GASOLINE STATION (X) 02 OTHER LABEL MANUFACTURER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> 1 <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/ARG CODE <br /> KERBS JIM A. 209-368-7814 KERBS, JIM A. 209-368-7814 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 28000 GALLONS ( ) UNKNOWN E. GOES THE CONTAINER STORE: (X) 01 WASTE f ) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? f 1 01 YES (X) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( 1 03 PREMIUM ( ) 04 DIESEL 1 1 05 WASTE OIL f 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 12 ( ) GAUGE (X) INCHES ( ) CM ( 1 UNKNOWN <br /> S. ( 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED ( 102 SINGLE WALLED t 103 LINED <br /> 0. t ) 01 CARBON STEEL ( 1 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( l 04 POLYVINYL CHLORIDE (X) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ] 08 BRONZE ( 1 09 COMPOSITE ( 1 10 NON-METALLIC <br /> t ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />