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• �`1� 0 y <br /> STATE ID NUMBER 00000010781009 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) 01 NEW PERMIT ( 1 05 RENEWED PERMIT ( 1 07 TANK CLOSED <br /> C ) 02 CONDITIONAL PERMIT ( ) 05 AMENDED PERMIT S 1 08 MINOR CHANGE (NO SURCHAR ) 09 [DELETE FROM FILE (NO FEEL <br /> I OWNER <br /> NAME(COPFOPATICN,INDIVIOUAL OR PUBLIC AGENCY) <br /> BERNARD H & PITA N PFLAUM PUBLIC AGENCY ONLY <br /> ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS <br /> 3401 S. WHISKEY SLOUGH RD. CITY STATE ZIP <br /> HOLT CA 95234 <br /> II FACILITY <br /> FACILITY NAME <br /> DEALER/FOREMAN/SUPERVISOR <br /> WHISKEY SLOUGH HARBOR B. PFLAUM <br /> STREET ADOPESS <br /> 3401 S. WHISKEY SLOUGH RD. NEAREST CROSS STREET <br /> LOWER JONES RD. <br /> CITr <br /> HOLT COUNTY ZIP <br /> SAN JOAQUIN 95234 <br /> MAILING ADDRESS CITY <br /> PO BOX 107 HOLT STATE ZIP <br /> CA 95234 <br /> EPHICINEREA CODE TYPE OF BUSINESS <br /> 931 O1 GASOLINE STATION fX) 02 OTHER MARTNA <br /> CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND RHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND RHONE W/AREA CODE <br /> PFLAUM, BERNARD 204-464-3931 PFLAUM, BERNARD 204-464-3931 <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 /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: ???? C. YEAR INSTALLED 1970 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 7000 GALLONS i ) UNKNOWN E. DOES THE CONTAINER STORE: { ) 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 /> (X) 01 UNLEADED i ) 02 REGULAR ( 1 03 PREMIUM { ) 04 DIESEL [ ) 05 WASTE OIL ( l 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES C ) CM (X) UNKNOWN <br /> B. € ) O1 VAULTED (LOCATED IN AN UNDERGROUND VAULT) f ) 02 NON—VAULTED (X) 03 UNKNOWN <br /> C. d J O1 DOUBLE WALLED [ ) 02 SINGLE WALLED ( J 03 LINED <br /> D. ( } 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS i ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> d 1 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE C } 09 COMPOSITE ( 1 10 NON—METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> ISC04-070185 (10/18/85) <br /> PAGE 1 <br />