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f <br /> STATE ID NUMBER 00000011982003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> (10) _01 NEW PERMIT ( ] 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 1 02 CONDITIONAL PERMIT f ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPROPATICN,INDIVIDUAL OR PUBLIC AOENCYI PUBLIC AGENCY ONLY <br /> WOOLSEY OIL INC. f ) 01 FED ( ) 02 STATE f 1 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 166 FRANK WEST CR. ST(KKTON CA 45231 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SU <br /> WOOLSEY OIL INC. Awa,- tr/evPCRVISOR <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 3686 W. COUNTRY CLUB COUNTRY CLUB A I-5 <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 9520w <br /> MPILING ADDRESS CITY STATE ZIP <br /> 166 FRANK WEST CR. STOCKTOM CA 95231:0 <br /> PHONE W/A P.EA CODE TYPE OF EUSINESS <br /> 209-948-9412 f ) O1 GASOLINE STATION (X) 02 OTHER HOME <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY 'TOWNSHIP RANGE SECTION <br /> .d3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAMC(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> WOOLSEY BRUCE 209-33i-i6w cf WOOLSEY BRUCE 209334-963C,{7'5-j rp <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( l 04 OTHER: CONTAINER NUMBER RDA-3 <br /> B. MANUFACTURER (IF APPROPRIATE): ACE YEAR MFG: 1984C. YEAR INSTALLED 1984 f 7 UNKNOWN <br /> 0. CONTAINER CAPACITY: S5'0_GALLONS f ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WAS�x�TEOIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE 8OX(ES): <br /> ( ) 01 UNLEADED ( ] 02 REGULAR f J 03 PREMIUM i= 04 DIESEL ( 1 05 WASTE OIL ( l 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE f ) INCHES ( 1 CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. f ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D., 01 CARBON STEEL ( ) 02 STAINLESS STEEL (X) 03 FIBERGLASS C ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM { ) 07 STEEL CLAD f l 08 BRONZE f l 09 COMPOSITE ( 1 10 NON-METALLIC <br /> f ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />