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6� <br />STATE ID NUMBER 0000 10D1 <br />APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK a]/� <br />( ) 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br />( 1 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br />!/ <br />n I.IAIC0 <br />IAME(COP FCRATION, INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br />iOWARD HOTLER ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br />(TREET ADDRESS CITYSTATE ZIP <br />STAR RT. BOX 54 FARMINGTON CA 95230 <br />LGn TI TTV <br />FACILITY NAME <br />THICKNESS OF PRIMARY <br />DEALER/FOREMAN/SUPERVISOR <br />( ) GAUGE ( ) INCHES ( <br />HOTLER <br />S <br />A. <br />( l 01 TANK (X) 04 OTHER: SUMP <br />STREET ADDRESS <br />CONTAINER <br />NEAREST CROSS STREET <br />\�6 <br />7305 N. WAVERLY RD. <br />MANUFACTURER (IF APPROPRIATE): <br />YEAR MFG: <br />C. <br />CITY <br />1949 ( ) UNKNOWN <br />COUNTY <br />CONTAINER CAPACITY: 500 GALLONS ( <br />IF <br />LINDEN <br />) 01 WASTE (X) <br />SAN JOAQUIN <br />F. <br />95236 <br />MAILING ADDRESS <br />IF YES CHECK APPROPRIATE <br />CITY <br />STATE <br />ZIP <br />7305 N. WAVERLY RD. <br />( ] 06 OTHER <br />LINOEN <br />CA <br />95236 <br />FHCNE W/AREA CODE <br />TYPE OF BUSINESS <br />209-887-3634 <br />( ) 01 GASOLINE STATION (X) 02 OTHER RANCH <br />NUMBER OF CONTAINERS <br />RURAL AREAS ONLY <br />TOWNSHIP <br />RANGE <br />SECTION <br />1 <br />T2N <br />R9E <br />S11 <br />III 24 HOUR EMERGENCY CONTACT PERSON <br />LAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAMEtLAST NAME FIRST) AND PHONE W/ARCA CODE <br />IATLERI NORMAN 209-887-3634 SAME - - <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION /N <br />V CONTAINER CONSTRUCTION <br />A. <br />THICKNESS OF PRIMARY <br />CONTAINMENT: <br />( ) GAUGE ( ) INCHES ( <br />) CM (X) UNKNOWN <br />S <br />A. <br />( l 01 TANK (X) 04 OTHER: SUMP <br />VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON -VAULTED ( <br />CONTAINER <br />NUMBER 1 <br />\�6 <br />B. <br />MANUFACTURER (IF APPROPRIATE): <br />YEAR MFG: <br />C. <br />YEAR INSTALLED <br />1949 ( ) UNKNOWN <br />D. <br />CONTAINER CAPACITY: 500 GALLONS ( <br />1 UNKNOWN <br />E. DOES THE CONTAINER STORE: ( <br />) 01 WASTE (X) <br />02 PRODUCT <br />F. <br />DOES THE CONTAINER STORE MOTOR VEHICLE <br />FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO <br />IF YES CHECK APPROPRIATE <br />BOX(ES): <br />( ] 01 UNLEADED (X) 02 REGULAR ( ) 03 <br />PREMIUM f ) 04 DIESEL ( ) 05 WASTE OIL <br />( ] 06 OTHER <br />V CONTAINER CONSTRUCTION <br />A. <br />THICKNESS OF PRIMARY <br />CONTAINMENT: <br />( ) GAUGE ( ) INCHES ( <br />) CM (X) UNKNOWN <br />S. <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 <br />(X) 02 SINGLE WALLED f <br />) 03 LINED <br />D. <br />(X) <br />f 1 <br />01 <br />( ) <br />12 <br />CARBON STEEL <br />06 ALUMINUM <br />UNKNOWN ( ) <br />( 7 02 STAINLESS STEEL ( <br />( ) 07 STEEL CLAD ( ) 08 <br />13 OTHER: <br />) 03 FIBERGLASS [ ) 04 <br />BRONZE ( ) 09 COMPOSITE <br />POLYVINYL CHLORIDE ( ) 05 CONCRETE <br />( ) 10 NON-METALLIC <br />HSC04-070185 (10/18/85) PAGE 1 <br />