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STATE ID NUMBER 00000016689001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ;10 O1 NEW PERMIT ( ) 05 RENEWEQ PERMI707 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> f02 CONDITIONAL PERMIT ( 7 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER - <br /> NAME(COP,POPATION,INDIVIDUAL OR PUBLIC AGENCY) JPU5LIC AGENCY ONLY <br /> k{IM7RUS CORPORATION—AOMfNSTRAT 01 FED ( ) 02 STATE 03 LOCAL <br /> CITY STATE ZIP <br /> STREET ADDRESS TUSTIN CA 92680 <br /> 17291 IRVINE BLVD.,SUITE 200 <br /> II FACILITY - <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> KIMTRUSS COROPORATION DOUGLAS J. MCBRIDE <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 16351 MCKINLEY AVE. LOUISE AVE. <br /> COUNTY ZIP <br /> CITY LATHROP SAN JOAQUIN 95330 <br /> EE <br /> __jCITY STATE ZIP <br /> Ma1LIN3 ADOPESS CA 95330 <br /> P.O.BOX 280 LATHRCP <br /> PHONE W/A.PEA GDE TYPE OF BUSINESS <br /> 209 7_56'i ( ) 01 GASOLINE STATION (X) 02 OTHER MANUFACTUR <br /> rc ❑ RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> F <br /> hSB_. C. CONTAINERS <br /> 1 <br /> IIi 24 HOUR EMERGENCY CONTACT PERSON <br /> FDAI,YS: NAMEfLAST NAME FIRST) AND PHONE /AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE�OE <br /> IOE,OOUGLAS J. 209— g��'— MCB(TIDE,DOUGLAS J. 209 + <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> LA. (X) OI TANK E 1 04 OTHER: CONTAINER NUMBER C-112 <br /> NUFACTURER (IF APPROPRLATEI� UNKOWN YEAR,, MFG* C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 2000 GALLONS i 1 UNKNOWN E. DOES THE CONTAINER STORE= C ) 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 /> ( 1 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM (X.) 04 DIESEL ( i 05 WASTE OIL l ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f ) GAUGE [ ) INCHES ( ) CM (X) UNKNOWN <br /> B. { ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON—VAULTED (X) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED 02 SINGLE WALLED ( ) 03 LINED <br /> D. ( )CO) 06RAOLUMINUML l( ))072STEELNCLAD STEEL <br /> 08CO3 BRONZEFIBERfa09SCOMPOSITE POLYVINYL <br /> NON—METADLLIC( ) 05 CONCRETE <br /> (X) 12 UNKNCWN ( ) 13 OTHER <br /> PAC <br /> HSC04-070185 (10/18/85) <br />