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. • STATE ID NUMBER 00000038113002 <br />APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br />(` 1 NEW PERMIT ( ) OS RENEWED PERMIT f l 07 TANK CLOSED <br />( ) 09 DELETE FROM FILE (110 FEE) <br />02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br />OWNER <br />PUBLIC AGENCY ONLY <br />IAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) ( ) 01 FED I 1 02 STATE ( 1 03 LOCAL <br />lANDEPOL ENTERPRISES, INC. <br />CITY STATE IIP <br />;TPEET ADDRESS STOCKTON CA 95203 <br />?700 W. WASHINGTON <br />II FACILITY <br />24 <br />HOUR <br />tMtKUtNCy Lun)H�l F�wlx <br />DEALER/FOREMAN/SVPERVISOR <br />FACILITY NAME <br />NAME FIRST) AND PHONE W/AREA CODE <br />VAN DE P 209-465-3421 <br />RONALD VANDEPOL <br />NIGHTS: NAME(LAST NAME <br />VANDEPOL RONALD <br />VANCO <br />W/ARE/ASCODE <br />NEAREST CROSS STREET <br />STREET ADDRESS <br />ALPINE <br />3230 N. WEST LANE <br />ZIP <br />COUNTY <br />95204 <br />CITY <br />SAN JOAQUIN <br />STOCKTON <br />STATE <br />ZIP <br />MAILING ADDRESS <br />CITY <br />STOCKTON <br />CA <br />95204 <br />3230 N. WEST LANE <br />RHONE W/AREA COOS <br />TYPE OF BUSINESS <br />IX) O1 GASOLINE STATION ( 7 02 OTHER <br />209-463-5103 <br />RURAL AREAS ONLY : <br />TOWNSHIP <br />RANGE <br />SECTION <br />NUMBER OF CONTAINERS <br />3 <br />nnocnAl <br />II <br />24 <br />HOUR <br />tMtKUtNCy Lun)H�l F�wlx <br />7AYS: NAME(LAST <br />(ONALO OR MARVIN <br />NAME FIRST) AND PHONE W/AREA CODE <br />VAN DE P 209-465-3421 <br />NIGHTS: NAME(LAST NAME <br />VANDEPOL RONALD <br />FIRST) AND PHONE <br />209-� <br />W/ARE/ASCODE <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. (X) 01 TANK ( ) 04 OTHER: <br />MANUFACTURER (IF APPROPRIATE): <br />CONTAINER NUMBER 02 <br />YEAR MFG: I C. YEAR INSTALLED (X) UNKNOWN <br />D CONTAINER CAPACITY 10000 GALLONS ( ) UNKNOWN IE DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br />F. DOES THE <br />RCONTAINER STORE <br />MOTOR VEHICLE <br />FUEL <br />ORMWASI DIESEL ( 1 <br />TOIL0YES <br />05 ( ) 02 <br />20IOO (I1 YES <br />OCHECK APPROPRIATE BOX(ES): <br />O <br />V CONTAINER CONSTRUCTION <br />A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES f ) CM (X) UNKNOWN <br />B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON -VAULTED (X) 03 UNKNOWN <br />C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED l 1 03 LINED <br />D. (X)(01 CARBON <br />ALUMINUM STAINLESS <br />STEEL03 <br />BRONZEFIBERG095COMPOSITE POLYVINYL <br />OS CONCRETE <br />NON-METALLIC( ) <br />( 1 12 UNKNOWN f 1 13 OTHER: <br />PAGE 1 <br />HSC04-070185 (10/18/85) <br />0 <br />