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%I/ *%o STATE ID NUMBER 00000010994004 <br />APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br />01 NEW PERMIT ( ) 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 />OWNEK <br />VAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br />TERESI TRUCKING INC ( l 01 FED ( ) 02 STATE ( 1 03 LOCAL <br />STGEET ADDRESS CITY STATE IIP <br />90r; 1/2 VICTOR ROAD LODI CA 95240 <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/AREA CODE <br />ihM SCHMIDKE TERMINAL MGR 209-368-2472 ASK ANSWERING SERVICE FOR 209-368-2472 <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />Tv nccrOTPTTnti <br />A. <br />(X) 01 TANK ( ) 04 OTHER: <br />( ) GAUGE ( ) INCHES ( <br />CONTAINER <br />FACILITY NAME <br />� <br />DEALER/FOREMAN/SUPERVISOR <br />YEAR MFG: 1973 <br />.��„ ' t� e-5 ( <br />I r LA `. <br />JOHN TERESI/PRES <br />CONTAINER CAPACITY: 4 W GALLONS ( <br />[iTREET ADDRESS <br />E. DOES THE CONTAINER STORE: (X) 01 WASTE ( 1 02 PRODUCT <br />NEAREST CROSS STREET <br />DOES THE CONTAINER STORE MOTOR VEHICLE <br />( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 <br />300 1/2 VICTOR ROAD <br />IF YES CHECK APPROPRIATE BOX(ES): <br />( ) 06 OTHER <br />BECKMAN ROAD <br />! 03 FIBERGLASS ( 1 04 <br />BRONZE f 1 09 COMPOSITE <br />..^.I TY <br />COUNTY <br />IF <br />LODI <br />SAN JOAQUIN <br />95240 <br />^FAILING ADDRESS <br />CITY <br />STATE <br />IIP <br />P.O. BOX7TI7_ 12:70LODI <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 <br />FUEL FACILIT <br />I <br />NUMBER OF CONTANERS <br />RURAL AREAS ONLY <br />TOWNSHIP <br />RANGE <br />SECTION <br />4 <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/AREA CODE <br />ihM SCHMIDKE TERMINAL MGR 209-368-2472 ASK ANSWERING SERVICE FOR 209-368-2472 <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />Tv nccrOTPTTnti <br />A. <br />(X) 01 TANK ( ) 04 OTHER: <br />( ) GAUGE ( ) INCHES ( <br />CONTAINER <br />NUMBER 4 <br />B. <br />MANUFACTURER (IF APPROPRIATE): <br />YEAR MFG: 1973 <br />C. <br />YEAR INSTALLED 1973 f l UNKNOWN <br />D. <br />CONTAINER CAPACITY: 4 W GALLONS ( <br />;UNKNOWN <br />E. DOES THE CONTAINER STORE: (X) 01 WASTE ( 1 02 PRODUCT <br />F. <br />DOES THE CONTAINER STORE MOTOR VEHICLE <br />( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 <br />FUEL OR WASTE OIL ? (X) 01 YES ( ] 02 NO <br />PREMIUM ( ) 04 DIESEL (X) 05 WASTE OIL <br />IF YES CHECK APPROPRIATE BOX(ES): <br />( ) 06 OTHER <br />V CONTAINER CONSTRUCTION <br />A. <br />THICKNESS OF PRIMARY CONTAINMENT: <br />( ) GAUGE ( ) INCHES ( <br />) CM (X) UNKNOWN <br />B. <br />( ) <br />01 <br />VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON -VAULTED ( <br />) 03 UNKNOWN <br />C. <br />( ) <br />01 <br />DOUBLE WALLED (X) 02 SINGLE WALLED ( <br />l 03 LINED <br />0. <br />(X) <br />( ) <br />01 <br />( ) <br />12 <br />CARBON STEEL ( 102 STAINLESS STEEL ( <br />06 ALUMINUM ( 7 07 STEEL CLAD ( ) 08 <br />UNKNOWN ( ) 13 OTHER= <br />! 03 FIBERGLASS ( 1 04 <br />BRONZE f 1 09 COMPOSITE <br />POLYVINYL CHLORIDE ( ) 05 CONCRETE <br />( ) 10 NON-METALLIC <br />HSC04-070185 (10/18/85) <br />PAGE 1 <br />