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• STATE ID NUMBER 00000037573001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 1 NEW PERMIT ( 1 05 RENEWED PERMIT t ) 07 TANK CLOSED <br /> ( ) 09 DELETE FROM FILE (NO FEE) <br /> 1 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( 1 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> PUBLIC AGENCY ONLY <br /> NAME(COPPOP.ATION.INDIVIDUAL OR PUBLIC AGENCY) ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> LAMMERSVILLE SCHOOL DIST. <br /> CITY STATE ZIP <br /> STREET ADDRESS TRACY CA 95376 <br /> 16555 W. VON $OSTEN RD. <br /> II FACILITY <br /> DEALER/FOREMAN/SUPERVISOR <br /> FACILITY NAME <br /> LAMMERSVILLE SCHOOL DIST. e,4A vk <br /> NEAREST CROSS STREET <br /> STREET ADDRESS n CJ ��` <br /> 16555 W. VON SOSTEN RD. <br /> COUNTY ZIP <br /> CITY SAN JOAQUIN 95376 <br /> TRACY <br /> STATE ZIP <br /> MAILING ADCCITY CA 95376 <br /> SS TRACY <br /> 16555 W. VONN SOSTEN R0. <br /> PHONE W/AP.EA CODE TYPE OF BUSINESS <br /> 209-835-0138 ( ) O1 GASOLINE STATION (X) 02 OTHER <br /> NUMBER OF CONTAINE P.S RURAL AREAS ONLY TOWNSHIP <br /> RANGE SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AN PHON W/AREA CODE _ <br /> KENNETH OLDS 209_953"3'8'1 $�s-Q SAME `� <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER <br /> B. MANUFACTURER (IF APPROPRIATE I: YEAR MFG: 1980 C. YEAR INSTALLED 1980 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 2000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( ] 01 WASTE (X) 02 PRODUCT <br /> F. DOESOTHE CONTAINER STORE <br /> ERMOTOR VEHICLE FUEL ORMWASXE 04LDIESEL 0( 1E 05 WASTE 20iL (I) 06SOTHERK APPROPRIATE BOX(ES): <br /> LEADED 02 <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( 1 GAUGE ( ) INCHES (. ) CM tX) UNKNOWN <br /> B. ( ) Ol VAULTED (LOCATED IN AN UNDERGROUND VAULT) NON-VAULTED rp 03 UNKNOWN <br /> C. ( 1 O1 DOUBLE WALLED (Y1 NGLE WALLED t 1 03 LINED <br /> U. ( 1(0) UMINUM ( <br /> CARBON L -1 <br /> )) STAINLESS <br /> STEEL 08( 03 BRONZEFIBERG09SCOMPOSITE POLYVINYL <br /> 10 NON-METALLIC( 1 05 CONCRETE <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> PAGE 1 <br /> HSC04-070185 (10/18/85) <br /> f <br />