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i• STATE ID NUMBER 00000038113003 <br />APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br />�1 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED <br />( ) 09 DELETE FROM FILE (NO FEE) <br />02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br />I OWNER <br />PUBLIC AGENCY ONLY <br />r2700 <br />OP.POPATION,INDIVIOUAL OR PUBLIC AGENCY) ( ) 01 FED ( 1 02 STATE ( 1 03 LOCAL <br />VANDEPOL ENTERPRISES, INC. <br />CITY STATE ZIP <br />ADDRESS STOCKTON CA 95203 <br />. WASHINGTON <br />II FACILITY <br />FACILITY NAME <br />VANCO <br />STREET ADDRESS <br />3230 N. WEST LANE <br />CITY <br />STOCKTON <br />MAILING ADDRESS <br />3230 N. WEST LANE <br />PHONE W/AREA CODE <br />209-463-5103 <br />NUMBER OF CONTAINERS <br />3 <br />DEALER/FOREMAN/SUPERVISOR <br />RONALD VANDEPOL <br />NEAREST CROSS STREET <br />ALPINE <br />SAN JOAQUIN <br />STOCKTON <br />ITYPEOF BV SINESS <br />(X) O1 GASOLINE STATION l 1 02 OTHER <br />RURAL AREAS ONLY : TOWNSHIP RANGE <br />III 24 HOUR EMERGENCY CONTACT PERSON <br />DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br />RONALD OR MARVIN VAN DE P 209-465-3421 <br />ZIP <br />95204 <br />STATE ZIP <br />CA 95204 <br />NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br />VANDEPOL, RONALD 209-45�7�3599 QS%'�.�i%C <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESGKIrliUN <br />(X) 01 TANK ( ) 04 OTHER: <br />B. MANUFACTURER (IF APPROPRIATE): <br />CONTAINER NUMBER 03 <br />YEAR MFG: I C. YEAR INSTALLED (X) UNKNOWN <br />0. CONTAINER CAPACITY: 10000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) O1 WASTE (X1 02 PRODUCT <br />F DOES OOTHE CONTAINER STORE <br />RMOTOR VEHICLE FUEL OR <br />RMWASTE OIL <br />L04 DIESEL 0( YES <br />05 WASTE 2OIL (II 06SOTHERK APPROPRIATE BOX(ES)' <br />ED 02 <br />EGULAR 03 <br />J CONTAINER CONSTRUCTION <br />A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br />B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON -VAULTED (X) 03 UNKNOWN <br />C. ( ) O1 DOUBLE WALLED (X) 02 SINGLE WALLED ( ] 03 LINED <br />03 04D. (X)(0; 0ARBON STEEL <br />((1)0STEEL 02STAINLESS <br />STEEL <br />08(BRONZEFIBERG09SCOMPOSITE PoL1V10YNONHMETALLICCLORIDE( ) OS CONCRETE <br />INUM <br />( J 12 UNKNOWN ( ) 13 OTHER: <br />PAGE 1 <br />ISC04-070185 (10/18/85) <br />