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0 <br />0 <br />STATE ID NUMBER 00000001% <br />APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br />(,Q 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO <br />f ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br />Ii�I"I:I <br />N.AME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br />USA PETROLEUM COMPANY ( ) 01 FED ( ) 02 STATE f 1 03 LO( <br />STREET ADDRESSCITY STATE ZIP <br />P.O. BOX 1839 SANTA MONICA CA 90406 <br />II FACILITY <br />FACILITY NAME <br />(X) 01 TANK ( ) 04 OTHER: <br />CONTAINER <br />DEALER/FOREMAN/SUPERVISOR <br />B. <br />USA PETROLEUM COMPANY <br />#65 <br />C. <br />YEAR INSTALLED 1971 ( 1 UNKNOWN <br />4mw- EiT27 _.nAl (D(.m sieA o <br />CONTAINER CAPACITY: 12000 GALLONS ( <br />STREET ADDRESS <br />E. DOES THE CONTAINER STORE: ( <br />) 01 WASTE (X) 02 PRODUCT <br />F. <br />NEAREST CROSS STREET <br />FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO <br />PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL <br />2500 W. LODI - <br />LOWER SACRAMENTO <br />CITY <br />COUNTY <br />ZIP <br />LODI <br />SAN JOAQUIN <br />95240 <br />MAILING ADDRESS <br />CITY 441 t <br />ZIP �i2 fG <br />STATE <br />. 1560 <br />()J. Lai <br />SAbgA_gHfft. <br />CA <br />9e4e6 <br />PHONE W/AREA CODE,// <br />TYPE OF BUSINESS <br />333 -1?-?q <br />I (X) 01 GASOLINE STATION E 1 02 OTHER <br />NUMBER. OF CONTAINERS � <br />� <br />RURAL <br />AREAS ONLY <br />TOWNSHIP <br />RANGE <br />SECTION <br />3 <br />III 24 HOUR EMERGENCY CONTACT PERSON <br />DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE 'NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br />MARK CONANT Ji7Al p SAME <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. <br />(X) 01 TANK ( ) 04 OTHER: <br />CONTAINER <br />NUMBER 1 <br />B. <br />MANUFACTURER (IF APPROPRIATE): <br />YEAR MFG: <br />C. <br />YEAR INSTALLED 1971 ( 1 UNKNOWN <br />D. <br />CONTAINER CAPACITY: 12000 GALLONS ( <br />1 UNKNOWN <br />E. DOES THE CONTAINER STORE: ( <br />) 01 WASTE (X) 02 PRODUCT <br />F. <br />DOES THE CONTAINER STORE MOTOR VEHICLE <br />(X) 01 UNLEADED ( ) 02 REGULAR ( ) 03 <br />FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO <br />PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL <br />IF YES CHECK APPROPRIATE BOX(ES): <br />f ) 06 OTHER <br />V CONTAINER CONSTRUCTION <br />A. THICKNESS OF PRIMARY CONTAINMENT: 1/4" fl GAUGE (X) INCHES ( l CM ( l UNKNOWN <br />B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON -VAULTED ( ) 03 UNKNOWN <br />C. ( ) 01 DOUBLE WALLED (X1 02 SINGLE WALLED ( ) 03 LINED <br />0. (X) 01 CARBON STEEL ( 1 02 STAINLESS STEEL ( ) 03 FIBERGLASS [ 1 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br />( ) 06 ALUMINUM f ) 07 STEEL CLAD ( 7 08 BRONZE ( l 09 COMPOSITE ( ) 10 NON-METALLIC <br />f 1 12 UNKNOWN ( ) 13 OTHER: <br />I'r HSC04-070185 (10/18/85) PAGE 1 <br />