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STATE ID NUMBER 00000010994002 <br />APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br />.81 NEW PERMIT ( l 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br />% 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br />I OWNER <br />NAME(CORPOPATION,iNO IVIDVAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br />TERESI TRUCKING INC l ) 01 FED ( l 02 STATE ( ) 03 LOCAL <br />STREET ADDRESS CITY STATE ZIP <br />900 1/2 VICTOR ROAD LODI CA 95240 <br />II FACILITY <br />FACILITY N�A�1yE <br />A,aaV� I Q_"Y'2.5 7 <br />(A <br />OTHER: <br />DEALER/FOREMAN/SVPERVISOR <br />JOHN TERESI/PRES <br />CONTAINER HUMBER 2 <br />S. <br />MANUFACTURER (IF APPROPRIATE): <br />YEAR MFG: 1973 <br />Fc. <br />YEAR INSTALLED 1973 f 1 UNKNOWN <br />STREET ADDRESS <br />CONTAINER CAPACITY: <br />10000 GALLONS ( l UNKNOWN <br />NEAREST CROSS STREET <br />CONTAINER STORE: ( <br />900 1/2 VICTOR ROAD <br />F. <br />DOES THE CONTAINER <br />( ) 01 UNLEADED ( <br />BECKMAN ROAD <br />01 YES ( ) 02 NO <br />( ) 05 WASTE OIL <br />CITY <br />CARBON STEEL ( <br />06 ALUMINUM ( l <br />UNKNOWN ( ) 13 <br />1 02 STAINLESS STEEL [ 1 03 FIBERGLASS f ) 04 <br />07 STEEL CLAD ( ) 08 BRONZE f ) 09 COMPOSITE <br />OTHER: <br />COUNTY <br />ZIP <br />LODI <br />SAN JOAQUIN <br />95240 <br />MAILING ADDRESS <br />CITY <br />STATE <br />ZIP <br />P.O. BOX -a" I <br />LODI <br />CA <br />95241 <br />PHONE W/AREA CODE <br />TYPE OF BUSINESS <br />209-368-2472 <br />( ) 01 GASOLINE STATION (X) 02 OTHER PRIVATE FUEL <br />FACILIT <br />NUMBER OF CONTAINERS <br />RURAL <br />AREAS ONLY <br />TOWNSHIP <br />RANGE <br />SECTION <br />4 <br />III 24 HOUR EMERGENCY CONTACT PERSON <br />SAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br />IM SCHMIDKE TERMINAL MGR 209-366-2472 ASK ANSWERING SERVICE FOR 209-368-2472 <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. <br />(X) 01 TANK ( ) 04 <br />OTHER: <br />) CM (X) UNKNOWN <br />CONTAINER HUMBER 2 <br />S. <br />MANUFACTURER (IF APPROPRIATE): <br />YEAR MFG: 1973 <br />Fc. <br />YEAR INSTALLED 1973 f 1 UNKNOWN <br />D. <br />CONTAINER CAPACITY: <br />10000 GALLONS ( l UNKNOWN <br />E. DOES THE <br />CONTAINER STORE: ( <br />) 01 WASTE (X) 02 PRODUCT <br />F. <br />DOES THE CONTAINER <br />( ) 01 UNLEADED ( <br />STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) <br />) 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL <br />01 YES ( ) 02 NO <br />( ) 05 WASTE OIL <br />IF YES CHECK APPROPRIATE BOX(ES): <br />f ) 06 OTHER <br />V CONTAINER CONSTRUCTION <br />A. <br />THICKNESS OF PRIMARY CONTAINMENT: ( <br />1 GAUGE ( ) INCHES ( <br />) CM (X) UNKNOWN <br />B. <br />( ) <br />01 <br />VAULTED (LOCATED <br />IN AN UNDERGROUND VAULT) <br />(X) 02 NON -VAULTED ( <br />) 03 UNKNOWN <br />C. <br />( ) <br />01 <br />DOUBLE WALLED ( <br />02 SINGLE WALLED ( l <br />03 LINED <br />D. <br />(X) <br />l 1 <br />01 <br />( ) <br />12 <br />CARBON STEEL ( <br />06 ALUMINUM ( l <br />UNKNOWN ( ) 13 <br />1 02 STAINLESS STEEL [ 1 03 FIBERGLASS f ) 04 <br />07 STEEL CLAD ( ) 08 BRONZE f ) 09 COMPOSITE <br />OTHER: <br />POLYVINYL CHLORIDE f 1 05 CONCRETE <br />( ) 10 NON-METALLIC <br />. HSC04-070185 (10/18/85) <br />14W <br />PAGE 1 <br />