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• • STATE IO NUMBER 00000007087001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> (X1 <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> RIVER CITY PETROLEUM, INC. ( I <br /> 01 FED ( 102 STATE 03 LOCAL <br /> STREET ADDRESS <br /> 850 DELTA LANE CITY STATE ZIP <br /> WEST SACRAMENTO CA 95691 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> FREDERICKSEN TANK LINES, INC LORN FREDERICKSEN <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 2313 WEST NAVY DRIVE TILLELEWIS <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95205 <br /> MAILING ADDRESS CITY <br /> STATE ZIP <br /> P.O. BOX 235 WEST SACRAMENTO CA 95691 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 916-371-4960 ( ) 01 GASOLINE STATION (XI 02 OTHER KEY LOCK STORAGE <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> 1 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(IAST NAME FIR5T) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> 24 HOUR DISPATCH 916-371-4655 24 HOUR DISPATCH 916-371-4655 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER FTL-3 <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: 1979 C. YEAR INSTALLED 1979 f ) UNKNOWN <br /> D. CONTAINER CAPACITY: 12000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES f ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( 1 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED t ) 02 SINGLE WALLED ( 1 03 LINED <br /> D. C STEEL ( 1 02 STAINLESS STEEL f 1 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 AL ( 7 07 STEEL CLAD t ) 08 BRONZE ( 1 09 COMPOSITE f 1 10 NON-METALLIC <br /> .NFf�lC�M!}p1ih� <br /> HSC04-070185 (10/18/85) <br /> PAGE 1 <br /> 1 <br />