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STATE IO NUMBER 00000030796002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> f ) 02 CONDITIONAL PERMIT [ ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INOIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> OMS'O14• 1 H9: ( ) 01 FED f ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY (�T STATE ZIP <br /> 9t7S ; max$ CA varlrg yp <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPE V,j SOR <br /> UNION OIL SS #4409 dAtlES-LMCCARTR-Y <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1502 NORTH EL DORADO HARDING <br /> CITY 45TATION <br /> Y IIP <br /> STOCKTON OAQUIN 95204 <br /> MAILING ADDRESS ,/ /�"�"� � STATE IIP <br /> 7TAt CXUF � 7 L CA 91264- 'F+ <br /> PHONE W/AP.EA CODE TYPE OF BUSINES <br /> 209-466-7666 (X) 01 GASOLIN ( ) 02 OTHER <br /> NUMBEROF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE 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 /> JAURIGUI, L.J. 415-9&6-?6e$ '?VS 7--ZUNION OIL CO. 415-661:-932£FCIS-� <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER *409-M <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1983 C. YEAR INSTALLED 1983 ( 1 UNKNOWN <br /> D. CONTAINER CAPACITY: 12000 GALLONS f 1 UNKNOWN E. "c ONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ). 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR (X) 03 PREMIUM ( ) 04 DIESEL f ) 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. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED f 1 03 LINED <br /> D. ( ) 01 CARBON STEEL f ) 02 STAINLESS STEEL f 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE l ) 05 CONCRETE <br /> ( 1 06 ALUMINUM ( ) 07 STEEL CLAD ( 1 08 BRONZE (X) 09 COMPOSITE ( l 10 NON-METALLIC <br /> [ ) 12 UNKNOWN f ) 13 OTHER: �51 C <br /> HSC04-070185 (10/18/85) PAGE 1 <br />