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{ �C STATE ID NUMBER 00000028380001 <br /> APPLICATION FOR PERMIT TO OPERATE UND-ERGROUND STORAGE TANK <br /> ( } <br /> 01 NEW PERMIT ( } 05 RENEWED PERMIT 06 ng ;ANct-QSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( 1 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> ESCALON PACKERS, INC. ( l 01 F-ED ( ) 02 STATE ( l 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 1905 MCHENRY AVE. ESCALON CA 95320 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOP.EMAN/SUPERVISOR <br /> ESCALON PACKERS, INC. DALE TAYLOR <br /> STPEET ADDP.ESS NEAREST CPOSS STREET <br /> 1905 MCHENRY AVE. FIRST STREET <br /> CITY COUNTY ZIP <br /> ESCALON SAN JOAQUIN 95320 <br /> MAILING ADDRESS CITY STATE ZIP <br /> P.O. BOX 8 ESCALON CA 95320 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-838-7341 ( ) 01 GASOLINE STATION (X) 02 OTHER PAKER <br /> NUMBER OF CONTAINERS PUPAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 1 25 9E 5 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/APEA CODE NIGHTS: NAMEILAST NAME FIRST] AND PHONE W/AREA CODE <br /> DALE TAYLOR 209-838-7341 �j,(�jf/r # SAME �Zpq 4Z7— <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( l 04 OTHER: CONTAINER NUMBER 1 l <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 540 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( J 01 WASTE (X) 02 PRODUCT i <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( 1 <br /> 01 UNLEADED (X) 02 REGULAR { ) 03 PREMIUM ( } 04 DIESEL ( 1 05 WASTE OIL ( l 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( l GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. f ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 -NON-VAULTED ( l 03 UNKNOWN <br /> C. f ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( 1 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( } 04 POLYVINYL CHLORIDE ( l 05 CONCRETE a <br /> ( ) 06 ALUMINUM f l 07 STEEL CLAD ( } 08 BRONZE ( ) 09 COMPOSITE ( 1 10 NONMETALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: + <br /> HSC04-070185 (10/18/85) PAGE , <br />