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S(Aft 1D NUMBER <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> E (NO FEET <br /> I ) 02 C01401TIONAL PERMIT 0b AMENOCO PERMIT ( 0Q MINOR CHANGE (NO SURCHARGE) <br /> ! 1 ! E <br /> -. (• .1_oI-NEW PERMIT-- _ -....-......_ ) 05 RENEWED PERMIT t 1 07 TANK CLOSED --_........ __._._._ _ ) 09 DELETE FROM Plla, ... .. . <br /> b I OWNER <br /> NAMS(COPVO*ATION.%NDIVIDUAL OR PueLIC AGENCY) LTC AGENCY ONLY <br /> SHARPS ARMY DEPOT SDSSH-EM 01 FED C 1 02 STATE t 1 03 LOCAs <br /> STREET ADIgISSC%TY $TATE ZTP <br /> Roth Rd, Environmental Program Office — Lathrop <br /> '« CA �+ 95331 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMEN/$tJPERV;SOA <br /> ..S. & E ARMY DEPOT_—SDSSH-EM <br /> STREET ADVIESS NEAREST CROSS STPEET <br /> ROTH ROAD, ENVIRONMENTAL PROGRAM OFFICE A Street on facility <br /> CITY _ <br /> LATHROP CCuSAN JOAQUIN ZIP 95331 <br /> MAYLING AOOPE$$ --__--��.i4• G%tY $TATE E20 <br /> ,S�_HARPE. ARMY DEPOT, ATTN. SDSSH-EM LATHROP CA - 953317-` <br /> PHONE WIAGEA COBE TYPE CP ®U$IN:SS <br /> �ng- 377Q ( 1 01 GASOLINE STATION XX) 02 OTHER <br /> NUM®ER OF CONTA;NEC$ IPVPAL AREAS( ONLY : IP RANGE SECTION <br /> YpWNSH <br /> I South 6 East 23 <br /> II1 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FSPST) AND PHONE: W/AREA CODE NIGNTS( NAMEtLAST NAME FZRSTI AND PHONE W/AREA CODE <br /> GUZMAN,_JOHN _. (209) 982-3779/3828 Fire Chief (209) 982-3802/2105 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> 1V DESCRIPTION <br /> A. YX1 01 TAt(K ( 1 02 OTHER( CONTAINER NUMBER <br /> 6. MANUFACTURER LIP APPRONRTATEt: YEAR t1f0s C. YEAR INSTALLED t e UNKNOWN <br /> 0. C014TA114ER CAPACITY( 500 GALLONS ( ) UNKNOW(( E. DOES THE CONTAINER STORE: ( 1 01 WASTE (XX 02 PRODUCT <br /> f. DOES THE CONTAINER STORE ROTOR VEHICLE FUEL OR WASTE OIL ? t ) 01 YES 02 NO IF YES CHECK APPROPRIATE 50y 51 1 ) 01 UNLEADED t D 02 REGULAR ( 1 03 PREMIUM (XX 04 DIESEL ( ) 05 WASTE OIL t ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> �A. THXCY..t(FSS OF PRIMARY CONTAINMENT( ( D GAUGE ( 1 It(CHES ( i CM K)? UNKNOWN <br /> B. t ) 01 VAULTED (LOCATED IN AN UNOERGROUND VAULT) LXX 02 NON-VAULTED t ! 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED " 02 SINGLE WALLED ( } 03 LINED <br /> D. (XK01 CARBON STEEL ( ) 02 STAINLESS STEEL t 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE�t ) OS CONCRETE — <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 06 BRONZE ( 1 OQ COMPOSITE ( ) 10 NON-METALLIC <br /> ( 1 12 UNKNOWN t ) 13 OTHER: <br /> 4SG04-0,x,0185 �~ PARE 1 <br /> ri <br /> r <br />