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*LEA110 NUMBER 00000010781008 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( l 09 DELETE FROM FILE (NO FEE) <br /> ( 1 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( T 08 MINOR CHANGE (NO SURCHARG ) <br /> I OWNER <br /> NAME(COPPCRATION,INDIVIDUAL OR PUBLIC AGENCY) <br /> PUBLIC AGENCY ONLY <br /> BERNARD H & RITA N PFLAUM E ) O1 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY FCA <br /> E ZIP <br /> 3401 S. WHISKEY SLOUGH RD. HOLT 95234 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> WHISKEY SLOUGH HARBOR B. PFLAUM <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 3401 S. WHISKEY SLOUGH RD. LOWER JONES RD. <br /> CITY <br /> COUNTY ZIP <br /> HOLT SAN JOAQUIN 95234 <br /> M?ILINC, kDDPcSS CITY STATE ZIP <br /> PO BOX 107 HOLT CA 95234 <br /> PHONE W/A.REA. CODE TYPE OF BUSINESS <br /> 209-464.3931 f I 01 GASOLINE STATION (X) 02 OTHER MARINA <br /> NUMBER OF CONTAINERSRURAL AREAS ONLY : TOWNSHIP Fyh'GE SECTION <br /> TION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> GAYS: NA.ME(LAST NAME FIRST) AND PHONE W/AREA CODE N23' TS: NAME(LAST NAME FIP.ST) AND PHONE W/A.PEA CODE <br /> PFLAUM, BERNARD 209-464-3931 PFLAUM, BERNARD 209-464-3932 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> FA. (X) 01 TANK i l 04 OTHER: jMFG; <br /> NTAINER NUMBER 4 <br /> B. MANUFACTURER (IF APPROPRIATE). UNKNOWYEAN C. YEAR INSTALLED 1973 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( l 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> E ) 01 UNLEADED f ) 02 REGULAR (X) 03 PREMIUM ( ) 04 DIESEL f ) 05 WASTE OIL [ ) 06 OTHER <br /> V CONTAINER, CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1/4 ( l GAUGE (X) INCHES ( l CM i ) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (XI 02 SINGLE WALLED ( ) 03 LINEO <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS f l 04 POLYVINYL CHLORIDE ( 3 05 CONCRETE <br /> f ) 06 ALUMINUM ( l 07 STEEL CLAD ( ) 08 BRONZE [ ) 09 COMPOSITE f ) 10 NON-METALLIC <br /> ( l 12 UNKNOWN ( ) 13 OTHER: <br /> HSCC4-070185 (10/18/85) <br /> PAGE 1 <br />