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• • STATE ID NUMBER 00000001734001 <br />APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br />01 NEW PERMIT ( l 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( l 09 DELETE FROM FILE (NO FEE) <br />( ) 02 CONDITIONAL PERMIT ( 7 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br />I OWNER <br />NAME(CORPOP.ATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br />-e ( ) O1 FED ( ) 02 STATE ( ) 03 LOCAL <br />STREET ADDRESS /? CITY STATE ZIP p� <br />cu-iF9L1)& �.(SO ,> ca L <br />1 II FACILITY <br />FACILITY NAME <br />THICKNESS OF PRIMARY CONTAINMENT: ( <br />) GAUGE ( ) INCHES ( <br />DEALER/FOREMAN/SUPERVISOR <br />UNION OIL SS# 5886 <br />( l 01 <br />VAULTED (LOCATED IN AN UNDERGROUND VAULT) <br />DARRELL EPPLER <br />STREET ADDRESS <br />C. <br />( ) 01 <br />NEAREST CROSS STREET <br />2701 WEST MARCH LANE <br />D. <br />( l 01 <br />f ) <br />( l 12.UNKNOWN <br />CITY <br />POLYVINYL CHLORIDE t ) 05 CONCRETE <br />( ) 10 NON-METALLIC <br />COUNTY <br />ZIP <br />STOCKTON <br />SAN JOAQUIN <br />95207 <br />MAILING ADD:ESS <br />G'T-rr <br />J r e <br />CITY T E Z I P <br />7 <br />BlrBC�T9N- W• I �-► V �C c �^� CAA <br />PHONE W/AREA COME <br />TYPE OF BUSINESS <br />209-473-7337 <br />(X) 01 GASOLINE <br />STATION [ ) 02 OTHER <br />NUMBER OF CONTAINERS <br />RURAL AREAS ONLY <br />TOWNSHIP <br />RANGE <br />SECTION <br />3 <br />IIII 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 />JAURIGUIr L.J. 415-95fr-9ir"—S—_UNION OIL CO.1(57 <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. (X) 01 TANK ( ) 04 OTHER: t:ONTAINER NUMBER 5voo=r-i <br />B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1982 C. YEAR INSTALLED 1982 ( ) UNKNOWN <br />D. CONTAINER CAPACITY: 12000 GALLONS ( I UNKNOWN JE. 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 />(X) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL t ) 06 OTHER <br />IV CONTAINER CONSTRUCTION <br />A. <br />THICKNESS OF PRIMARY CONTAINMENT: ( <br />) GAUGE ( ) INCHES ( <br />) CM (X) UNKNOWN <br />B. <br />( l 01 <br />VAULTED (LOCATED IN AN UNDERGROUND VAULT) <br />(X) 02 NON -VAULTED ( <br />) 03 UNKNOWN <br />C. <br />( ) 01 <br />DOUBLE WALLED (X) 02 SINGLE WALLED ( ) <br />03 LINED <br />D. <br />( l 01 <br />f ) <br />( l 12.UNKNOWN <br />CARBON STEEL ( ) 02 STAINLESS STEEL (X) 03 FIBERGLASS ( ) 04 <br />06 ALUMINUM ( l 07 STEEL CLAD ( l 08 BRONZE ( l 09 COMPOSITE <br />( ) 13 OTHER: <br />POLYVINYL CHLORIDE t ) 05 CONCRETE <br />( ) 10 NON-METALLIC <br />4 HSC04-070185 (10/18/85) <br />PAGE 1 <br />