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STATE ID NUMBER 00000023486001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> (K)_01 NEW PERMIT ( l 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE CNO FEE) <br /> r-1-02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT t ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CCRPCRATiON,ZNDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> .;IM R MARY CATALINE ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> 151TOfCKT�0:M <br /> STATE ZIPSTREET ADCPESS CA 95205 <br /> ,19812 E. GAWNE RD. <br /> lI FACILITY <br /> ACILITY NAME DEALER/FOREMAN/S PERVISOP <br /> �STPEET ADDPESS NEAREST CROSS STREET <br /> 1405 MAIN ST. <br /> i- <br /> CITY COUNTY ZIP <br /> �ESCALON <br /> SAN JOAQUIN 95320 <br /> ` AILING ADDRESSCITY STATE ZIP <br /> M <br /> 1405 MAIN ST. ESCALON CA 95320 <br /> PHONE LJ/AP E.4 CODE 7]!��REOF :GASOLINE <br /> INESS <br /> 209-838-7621 01 <br /> STATION ( ) 02 OTHER <br /> NUMBER. OF CONTAINERS PUPAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 1 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> OAYS' NAME(LAST NAME FIRST) AND PHONE W/APIA CODE NIGHTS: NAME(LAST NAME FIRST) .AND PHONE W/AP.EA CODE <br /> CATALINE JIM 209-838-7546 SAME - <br /> COMPLETE HE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER, <br /> IV DESCRIPTION <br /> A. (X) 01 TA)JK [ ) 04 OTHER: CONTAINER NUMBER 3 <br /> lcf 4? <br /> B. MANUFACTURER (IF APPROPRIATE) YEAR MFG: C. YEAR INSTALLED - ( ) UNKNOWN <br /> 0. CONTAINER CAPACITY= 5000 GALLONS ( ) UNKNOWN E. DOES TME 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 t ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT= ( l GAUGE t ) INCHES ( ) CM (X) UNKNOWN <br /> B. t ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) IX) 02 NON-VAULTED ( i 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED 1 ) 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL f ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS C ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> { l 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />