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• • STATE ID NUMBER 00000030803002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> (K) 01 NEW PERMIT ( 1 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 /> 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS RX-VI <br /> //� I, <br /> 1. F LY CITY (�T— STATE ZIP <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> UNION OIL SS #6071 WILBUR T. HALL <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 4170 EAST WATERLOO RD. HWY 99 <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95205 <br /> MAILING ADDRESS > 7�/ �/�(I/A CITYy7,,/ //' /, <br /> '77R �!g-T u .a� (S`VK ul✓I //LV GC .11J.9LJ'$FamTe(f^ TNU��I�� CAATE ZIP �C <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-931-2524 (X) 01 GASOLINE STATION ( ) 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> 3 <br /> % III 24 HOUR EMERGENCY CONTACT PERSON <br /> OATS: NAME(LAST NAME FIRST) AND PHONE W/AR/E/A CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> JAURIGUI, L.J. 415- Y�?& UNION OIL CO. 415-&63-9322 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINE <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( 1 04 OTHER: CONTAINER NUMBER AQiL �-r Z <br /> S. MANUFACTURER (IF APPROPRIATE): E YEAR MFG: 1968 C. YEAR INSTALLED 1968 ( 7 UNKNOWN <br /> D. CONTAINER CAPACITY: 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 ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR (X) 03 PREMIUM ( ) 04 DIESEL ( 1 05 WASTE OIL ( l 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 (X) 02 SINGLE WALLED ( 7 03 LINED <br /> D. (X) 01 CARBON STEEL ( 1 02 STAINLESS STEEL ( ] 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> ( l 06 ALUMINUM ( 1 07 STEEL CLAD ( 1 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( 1 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) <br /> PAGE 1 <br />