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ell <br /> STATE ID NUMBER C0000060764001 <br /> APPLICATION FOR PERMIT TO OPERATE U QERGROUND STORAGE TANK <br /> (JEJ 01 NEW PERMIT E 1 05 RENEWED PERMIT C 1 07 TANK CLOSED _ D9 DELETE FROM FILE (NO FEE) <br /> ( ) <br /> 02 CONDITIONAL PERMIT f 1 06 AMENDED PERMIT t ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPOPATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> div ( ) 01 FED ( ) 02 STATE t 1 03 LOCAL <br /> STREET A.CDPESS CITY C: STATE <br /> ZIP <br /> II FACILITY <br /> FACILITY NAME DEALER/FOPEM.AN/SUPERVISOR <br /> UNION OIL SS# 5421 WALTER S. ORR <br /> ST2EET ADDRESS NEAREST CROSS STREET <br /> 7303 PACIFIC AVENUE WILLORA <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95207 <br /> MAILINZ ADDRESS ^� AA CITY STATE ZIP <br /> ca!7 le. c 4Yec1�rOFJ CA <br /> PHONE W/APER CCD! TYPE OF BUSINESS <br /> 209-478-0342 (X) 01 GASOLINE STATION ( ) 02 OTHER <br /> NUMBER OF CONTAINERS P.UPAL AREAS CN LY TOWNSHIP RANGE SECTION <br /> 1 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIPST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> JAURIGUI� L.J. 415- UNION OIL CO. <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. ( ) 01 TANK (X) 04 OTHER: SUMP CO"1TAINER NUMBER 5421-10-1 <br /> B. MANUFACTURER {IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> O. CONTAINER CAPACITY: GALLONS fX1 UNKNOWN E. DOES THE CONTAINER STORE= (X) 01 WASTE ( ) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? t ) 01 YES (X) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( 1 04 DIESEL [ ) 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 6 ( 1 GAUGE (X) INCHES ( ) CM ( 1 UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED t 1 03 LINED <br /> D. t 1 01 CARBON STEEL C ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS t ) 04 POLYVINYL CHLORIDE (X) fly CONCRETE <br /> ( ) 06 ALUMINUM i 1 07 STEEL CLAD ( ] 08 BRONZE C 1 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( 1 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />