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0 <br />n <br />0 <br />STATE ID NUMBER <br />APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br />( 1 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( .1 09 DELETE FROM FILE (NO FEE <br />( ) 02 CONDITIONAL PERMIT ( D 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br />I OWNER <br />NAME(COPPORATION,INCIVIDUAL OR PUBLIC A0E CY) PUBLIC AGENCY ONLY <br />Clition Oil 60mrany of (�alifor)1ia A dloq ) 01 FED ( D 02 STATE c ) 03 LOCAL <br />STREET ADDRESS /�t <br />2175,N. (,G(Il�ipy�yi)q E31�1., SLAltG told CITY STATE ZIP <br />----- Walnert Creua <br />ca "1459 Cv <br />II FACILITY <br />FACILITY NAME <br />( ) 01 TANK ( ) 02 OTHER: <br />DEALER/FCREMEN/SUPEPVISOP <br />CONTAINER NUMBER <br />STREET ADDRESS <br />MANUFACTURER (IF APPROPRIATE): <br />NEAREST <br />CROSS STREET <br />D. <br />CITY <br />JE. DOES THE CONTAINER STORE: ( 1 01 WASTE ( ) 02 PRODUCT <br />COUNTY <br />DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES ( 1 02 NO IF YES CHECK APPROPRIATE BOX(ES1: <br />( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br />ZIP <br />MAILING ADDRESS <br />CITY <br />STATE <br />ZZP <br />PHONE W/AREA CODE <br />TYPE OF BUSINESS <br />01 GASOLINE STATION ( <br />1 02 OTHER <br />NUMBER OF CONTAINERS <br />PUPAL AREAS ONLY : <br />TOWNSHIP <br />RANGE l�SECTION <br />11I 24 HOUR EMERGENCY CONTACT PERSON <br />L�_ <br />YS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br />a Fdr lu�c' ' R.L. i4'S11 945.7fo?Cp - - <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. <br />( ) 01 TANK ( ) 02 OTHER: <br />CONTAINER NUMBER <br />B. <br />MANUFACTURER (IF APPROPRIATE): <br />YEAR MFG:C. <br />YEAR INSTALLED ( ) UNKNOWN <br />D. <br />CONTAINER CAPACITY: GALLONS t ) UNKNOWN <br />JE. DOES THE CONTAINER STORE: ( 1 01 WASTE ( ) 02 PRODUCT <br />F. <br />DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES ( 1 02 NO IF YES CHECK APPROPRIATE BOX(ES1: <br />( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br />V CONTAINER CONSTRUCTION <br />A. THICKNESS OF PRIMARY CONTAINMENT: ( 1 GAUGE ( ) INCHES ( ) CM l D UNKNOWN <br />01 VAULTED (LOCATED IN AN UNOERGROUNO VAULT) t ) 02 NON—VAULTED t 1 03 UNKNOWN <br />C. t 1 01,DOUBLE WALLED ( D 02 SINGLE WALLED ( 103 LINED <br />D. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( D 04 POLYVINYL CHLORIDE ( D 05 CONCRETE <br />t 1 06 ALUMINUM ( D 07 STEEL CLAD ( 1 08 BR014ZE ( 1 09 COMPOSITE ( D 10 NON-METALLIC <br />t D 12 UNKNOWN ( D 13 OTHER: <br />ISC04-070185 <br />6 <br />PAGE I <br />