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• 000 <br /> STATE ID AN kUMB`Ep <br /> UMBER 00000 0781006 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( 1 01 NEW PERMIT [ ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ) 09 DELETE FROM FILE (NO FEE) <br /> ( 1 02 CONDITIONAL PERMIT f ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO 5URCHAR ) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> BERNARD H & RITA N PFLAUM ( ) 01 FED ( ) 02 STATE [ ) 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 /> STFEET ADDRESS NEAREST CROSS STREET <br /> 3401 S. WHISKEY SLOUGH RD. LOWER JONES RD. <br /> CITY COUNTY <br /> ZIP <br /> HOLT SAN JOAQUIN 95234 <br /> MAILING ADDRESS CITY STATE ZIP <br /> PO BOX 107 HOLT CA 95234 <br /> PHONE W/AREA COD'- 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 /> OATS: NAME(LAST 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 2 <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: C. YEAR INSTALLED 1973 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: f ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES [ 1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED (X1 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1/4 ( ) GAUGE (X) INCHES ( ) CM ( 1 UNKNOWN <br /> B. ( 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED f ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( 1 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ] 04 POLYVINYL CHLORIDE ( 1 OS CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( 1 08 BRONZE ( 1 09 COMPOSITE ( 1 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />