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STATE Ib NUMBER 00000010781003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSEDf ] 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT f ) 08 MINOR CHANGE (NO SURCHARG <br /> I OWNER <br /> NAME(COPPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> BERNARD H & RITA N PFLAUM ( 1 01 FED f 1 02 STATE ( 7 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 3401 S. WHISKEY SLOUGH RD. HOLT CA 95234 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> WHISKEY SLOUGH HARBOR B. PFLAUM <br /> STREET ACDPESS NEAREST CROSS STREET <br /> 3401 S. Ir'H ISKEY SLOUGH RD. LOWER JONES RD. <br /> CITY <br /> COUNTY ZIP <br /> HOLT SAN JOAQUIN 95234 <br /> MAILING ADDRESS CITY <br /> PO BOX 107 HOLT STATE IIP <br /> CA 95234 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-464-3931 ( ) 01 GASOLINE STATION (X) 02 OTHER MARINA <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> 9 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(IAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> PFLAUM, BERNARD 209-464-3931 PFLAUM, BERNARD 209-464-3931 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 1 <br /> S. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1975 ( ) UNKNOWN <br /> 0. CONTAINER CAPACITY: 2000 GALLONS [ 7 UNKNOWN E. DOES THE CONTAINER STORE: ( 101 WASTE IX) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? f ) 01 YES (X) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL f ) 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN 0 <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( 1 03 LINED <br /> D. ( 7 O1 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( 7 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> ( ) 06 ALUMINUM f ) 07 STEEL CLAD ( 1 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ' (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) <br /> PAGE 1 <br />