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0/27/2003 23:53 0000000E ALEXANDER , PAGE 02 <br /> STATE TO NUMt3EiR 00000048386: l <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 161-01 NEN PERMIT t ) 05 RENEWED PERMIT i ) 07 TANK CLMEO l 1 09 DELETE fROM FILE 4WD <br /> t ) at cOr;CITIONAL PERMIT ( ) 06 AMEHOEO PERMIT t ! 08 til"m CHANGE tN0 SMCHARGE) .J <br /> I OWNER <br /> NA�!fCORRCPATxON,:KO`.V!OUAL OR OUR)LSC AOEHCV) ,: PUSLTC AGENCY ONLY <br /> STEPHEN J. SARDELLA, 30. i ) 01 FED t ) 62 STATE t );a3 R= 1L <br /> STP[YT A930203 CITY STATE ZIPS <br /> P.O. BOX E24 [victoR CA 95253 <br /> II FACILITY <br /> 091Lt9RIEOP[PIAN/IUPERVI=OR <br /> 3TEFArIOIS GASOLINE STEPHEN GARDELLA <br /> $TRt[T AUNR[SS NEAREST CEOs LTRMIT <br /> 1419 E. CHARTER MAT WILSON NAY <br /> C:Yy ^=LINTY tit <br /> sTOCKTDht ' 80 JOAQUIN. 95tOS <br /> n�_t:NO AOOR;$s CITY STATE ix� <br /> P.O, box 2=4 VICTOR CA 95253 <br /> C„Ax! W/ARRA cae[ TYPS OF ailt:HESR: <br /> 209-366-1245 i ) 01 SASOL;NE STATION (XI 02 MER <br /> VV'1E'R QP aGNTAIN[Ri RUNAL AREAS OMtY ; TOWKSKIP RANGE $2CT:ON <br /> 2 <br /> III E4 HOUR EMERGENCY CONTACT PERSON <br /> DAPS: NAr, NIG�1T0: MAffL(l+►iT !RAMS RIR=T) AMO PHONE Yi/ARRA CODE <br /> GAROELLA, STEPHEN 'J.,SR. 209-366-1248 SAROELLA. 3TEPKEN J. 209-368-1243 <br /> l(L&ST N4�.,t OPIRST) AkO PltONI W/ADEA �002 <br /> COMPLETE THE FOLLOWING -ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK i ) 04 OTHER) ]CONTAINER NUMDER 81 <br /> S. MANUFACTURER SIF APPROPRIATElt ftWtNS TEAR ift” 1971 'AIVYI 1 ow iV <br /> b. CONTAINER CAPACtTT= 10000 GALLONS t ) UNKH" E. DOE$ THE CONTAINER STORES I ! O), WASTE tX) 02 PRODUCT <br /> F. DOES THE CCNTAIHER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? tX) 01 Y93i ti ) 0# NO IF YES CHECK APPROPRIATE'BOX( S <br /> i ) 01 UNLEADED iX) 02 OEGULAiR i ? 03 PREMIUM C ) 04 DIESEL t ) 05 MASXE OIL L 1" 04 OTNIIR <br /> V CONTAINER CONSTRUCTION <br /> A. TPttCKNISS OF PRIMARY CONTAINMENT: 1/4 t ! OAVOt (X) 1NCNE5 [ !) CM t ) M"94" <br /> 3. ( ) 01 VAULTEO (LOCATED IN AN UNDEACRMM VAULT) (X) Ot MON-VAULTED t i 03 UWJ4OWN <br /> C. ( ! 01 DDUSL9 WALLED iX) Ot SINGLE WALLED i ) 03 UNED <br /> D. (X) 01 CARM STEEL ( ) 02 STAINLESS STEEL i ) 93 Fts#!'t6LAs3 t r 04 POLYVINYL CHLORIDE [ r as CONCRETE- <br /> I ) 06 ALUMINUM t -) 07 STEEL CLAD t ) '08 BRONZE ( ) 01 Como;ITE R ) 10 NOlN-MEtAL42C <br /> t ) 12 UhJmw t ) 13 OTHEQ= <br /> HSC04-070185 t10t18/85) F ' 1 <br />