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00 •• STATE ID NUMBER 00000001734002 <br />APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br />C,01 NEW PERMIT ( ) 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(COP.PORATION INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br />oM=VIa"UIC-00. ( ) 01 FED ( l 02 STATE [ ) 03 LOCAL <br />STREET ADDRESS x CITY STATE ZIP <br />e / A3�fS t <br />{ II FACILITY <br />FACILITY NAME <br />THICKNESS OF PRIMARY <br />DEALER/FOREMAN/SUPERVISOR <br />( ) GAUGE ( ) INCHES ( <br />UNION OIL SS# 5886 <br />B. <br />DARRELL EPPLER <br />VAULTED (LOCATED IN AN UNDERGROUND VAULT) <br />STREET ADDRESS <br />) 03 UNKNOWN <br />NEAREST CROSS STREET <br />( ) 01 <br />2701 WEST MARCH LANE <br />(X) 02 SINGLE WALLED ( <br />) 03 LINED <br />CITY <br />( ) 01 <br />( ) <br />( ) 12 <br />COUNTY <br />( l 02 STAINLESS STEEL <br />( l 07 STEEL CLAD ( ) 08 <br />13 OTHER: <br />ZIP <br />STOCKTON <br />SAN JOAQUIN <br />95207 <br />MAILING ADDRESS <br />S'7� <br />CITY <br />STATE <br />ZIP <br />r <br />77FBfi <br />BN <br />CA <br />4&ao- - Q ys7p <br />P W R CODE <br />TYPE OF BUSINESS <br />Cleg 473d <br />(X) 01 GASOLENE STATION ( ) 02 OTHER <br />NUMBER OF CONTAINERSRURAL <br />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 />JAURIGUI, L.J. UNION OIL CO. <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. (X) 01 TANK ( ) 04 OTHER ICONTAINER NUMBER 5886-2---k , <br />B. <br />886 2--- <br />B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1982 C. YEAR INSTALLED 1982 t ) UNKNOWN <br />D. CONTAINER CAPACITY: 12000 GALLONS ( ) 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 />( ) 01 UNLEADED ( 1 02 REGULAR (X) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br />IV CONTAINER CONSTRUCTION <br />A. <br />THICKNESS OF PRIMARY <br />CONTAINMENT: <br />( ) GAUGE ( ) INCHES ( <br />) CM (X) UNKNOWN <br />B. <br />( ) 01 <br />VAULTED (LOCATED IN AN UNDERGROUND VAULT) <br />(X) 02 NON -VAULTED ( <br />) 03 UNKNOWN <br />C. <br />( ) 01 <br />DOUBLE WALLED <br />(X) 02 SINGLE WALLED ( <br />) 03 LINED <br />0. <br />( ) 01 <br />( ) <br />( ) 12 <br />CARBON STEEL <br />06 ALUMINUM <br />UNKNOWN ( ) <br />( l 02 STAINLESS STEEL <br />( l 07 STEEL CLAD ( ) 08 <br />13 OTHER: <br />(X) 03 FIBERGLASS t ) 04 <br />BRONZE ( ) 09 COMPOSITE <br />POLYVINYL CHLORIDE ( ) 05 CONCRETE <br />( ) 10 NON-METALLIC <br />F HSC04-070185 (10/18/85) <br />PAGE 1 <br />