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STATE ID NUMBER 00000029713003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ('(1 01 NEW PERMIT ( ) 05 RENEWED PERMIT A 07 TANK CLOSED (p) 09 DELETE FROM FILE (NO FEE) <br /> l 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT [ ) 08 MINOR CHANGE (NO SURCHARGE <br /> I OWNER <br /> NAME(CORPORATION.INDIV DUAL OR PUBLIC AGENCY PUBLIC AGENCY ONLY <br /> ( ) 01 FED ( ) 02 STATE f ) 03 LOCAL <br /> STREET ADDPESS CITY STATE ZIP <br /> 19901 SO. MCHENRY AVENUE ESCALON CA 95320 <br /> II FACILITY <br /> FACILITY NAME • '� / DEALER/FOREMAN/SUPERVISOR <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 19901 S0. MCHENRY AVENUE CLOUGH AVENUE <br /> PESCALON <br /> OUNTY ZIP <br /> ESCA LON AN JOAQUIN STATE ZIP <br /> CITY <br /> 95320 <br /> MAILING ADOPESS <br /> P.O. BOX 67 CA 95320 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-838-3564 ( ) 01 GASOLINE STATION (X1 02 OTHER FRESH FRUIT PROCESSI <br /> NUMBER. OF CONTAINERS RU PAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> 4 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: N'AME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> �pRgA 209-838-3809 i'R:Flmi-6+" FARGit <br /> J <br /> � MPLETE THE FOLLOWING ON A SEPAR TE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X1 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 3 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1978 C. YEAR INSTALLED 1978 ( ) UNKNOWN <br /> yi�Je/f's'Z <br /> 0. CONTAINER CAPACITY: 10000 GALLONS ( 1 UNKNOWN E. DOES THE CONTAINER STORE: ( ) O1 WASTE (X) 02 PRODUCT <br /> F. DOES 01 UNLEADED CONTAINER STORE <br /> RERMOTOR VEHICLE FUEL ORMW 04L0IESEL O( )E05 WAST020NOL fI) YES <br /> S06 OCHECK APPROPRIATE BOX(ES): <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( I INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL f l 03 FIBERGLASS [ l 04 POLYVINYL CHLORIDE [ ) 05 CONCRETE <br /> ( ) 06 ALUMINUM (X) 07 STEEL CLAD l ) 08 BRONZE ( l 09 COMPOSITE ( 1 10 NON-METALLIC JI <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> PAGE 1 <br /> HSC04-070185 (10/18/85) <br />