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STATE ID NUMBER 00000035679001 <br /> APPLICATION FOR PERMIT TO OP RATE UNDERGROUND STORAGE TANK <br /> ( NEW PERMIT ( ) 05 RENEWED PERMIT7 TANK CLOSED ( ) 09 DELETE FROM FILE Q EE) <br /> F <br /> 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT _?4)IS MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> WOODBRIDGE GOLF & COUNTRY CLUB ( ) 01 FED ( ) 02 STATE f ] 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 800 E. WOODBRIDGE RO CA 95258 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR v y <br /> WOODBRIDGE GOLF 3 COUNTRY CLUB GR. <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 800 E. WOODBRIDGE ROAD LWR. SACTO. ROAD <br /> CITY COUNTY ZIP <br /> WOODBRIDGE SAN JOAQUIN 95258 <br /> MAILING ADDRESS CITYSTATE ZIP <br /> P.O. BOX 806 WOODBRIDGE CA 95258 <br /> PHONE W/APEA CODE TYPE OF BUSINESS <br /> 209-368-6100 ( ) 01 GASOLINE STATION f ) 0.2 OTHER <br /> NUMBER. OF CONTAINERS RURAL AREAS ONLY TOWNSHIP .RANGE SECTION <br /> 2 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) ANO PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> 209-368- 6100 c20�' <br /> 'CO PLETE THE FOLLOWING ON A SEPARATE FORM OR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK. ( ) 04 OTHER: CONTAINER NUMBER 1000 -. <br /> B. MANUFACTURER (IF APPROPRIATE): PERKINS WELDING YEAR MFG: 1980 C. YEAR INSTALLED 1980 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 GALLONS ( ) 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 /> ( ) 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM. f ] 04 DIESEL f ) 05 WASTE OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 10 (X) GAUGE f ] INCHES ( ) CM ( ) UNKNOWN <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. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE f 1 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />