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STATE ID NUMBER 00000021167001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> O1NEW PERMIT ( ) 05 RENEWED PERMIT ( 1 07 TANK CLOSED ( ) 09 DELETE FROM FILE (N FEE) <br /> 1 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT 1 1 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAM!(CORPOPATION,INDIVIOUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> R. B. MATHESON HOLDINGS ( 1 01 FE f l 02 STATE ( 1 03 LOCAL <br /> STREET ADDRESS CITYiTATE IIP <br /> 2445 VISTA DEL MONTE CONCORD CA 94509 <br /> II FACILITY <br /> FACILITY NAME DEALUI/FOREMAN/S PERMS R l <br /> LODI YARD Rat -'CMiISE 4C u- <br /> STREET ADDRESS NEAREST CRO RE! <br /> 102 E. WALNUT LODI AVE. <br /> CITY COUNTY IIP <br />'LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESS n CITY (TATE <br /> Jt�.�ltiX-1iA4G.� (-1 �DD YY CA ». <br /> PHONE W/APIA CODE TYPE OF OUSSNESS <br /> 209-368-0666 ( ) 01 GASOLINE STATION (X) 02 OTHER TRUCKING COMPANY <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 4 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> iDAYS: NAME(LAST NAME FIRST) AND PHONE W/ARCA COD! NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/ARCA CODE <br />�,XmABET-ESt:tX209-368-8666•- L 91�-i92-9?8i6- <br /> (1"1) <br /> OMPLETE T FOLT RATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: . CONTAINER NUMBER GAS <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED IX) UNKNOWN <br /> 0. CONTAINER CAPACITY: 8000 GALLONS ( 1 UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? 1 ) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( I <br /> 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( 1 04 DIESEL ( 1 05 WASTE OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f 1 GAUGE ( 1 INCHES ( 1 CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br />'D. (X) 01 CARBON STEEL ( 1 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 1 07 STEEL CLAD ( 1 08 BRONZE ( l 09 COMPOSITE ( l 10 HON-METALLIC <br /> ( 1 12 UNKNOWN ( ) 13 OTHER: <br />(SC04-070185 (10/18/85) PAGE 1 <br /> yam[- �Pns' <br />