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®STATE ID/NU�fUER <br /> APPLICATION FOR PERMIT TO OP ATE UNDERGROUND STOR E TANK <br /> t ) 01 NEW PERMIT ( ) OS RENEWED PERMIT t 07 TANK CLOSED — (.� 09 0EL�Pr,E FROM FILE (NO FEE)-1 <br /> t ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) II <br /> I OWNER <br /> (CORRORATEON.INDEVEOUAI OR FUOIIC AOENCY) PUBLIC AGENCY ONLY <br />[NAME <br />__-r Desert Petroleum t ) O1 FED t 1 02 STATE ( ) 03 LOCAL_ <br /> STREET ADDRESS CITY STATE :h ZIP• <br /> i P.O. Box 1601 Oxnard CA 93032 <br /> II FACILIT.Y. <br /> FACILITY NAME DEALER/FOREMEN/SUPERVISOR <br /> Gasco Station #787 � <br /> STREET ADOPESS NEAREST CROSS STREET <br /> 950_ W. . 11th Coblid e <br /> CITY COUNTY ZIP' <br /> Tracy Sin Jilqune 95386 <br /> MAIL INO ADOPISS CYTY STATE' ZIP <br /> _ 950 W.` 11th. Tracy <br /> PHONE W/AVIA CODE TYPE OF SUSENESS <br /> 209 836 99j O "` (X) 01 GASOLINE STATION ( ) 02 OTHER <br /> NUMOER OF CONTAINERS RURAL AREASONLY : TOWNSHIP RANGE SECTION <br /> One (1) <br />'III. 2`t HOURtl EMERGENCY. CONTACT PERSON <br /> FOAYS: HAMCCLAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/APEA COOLCOOL <br /> ohn Rutherford 805-644-6784 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FO'R EACH CONTAINER <br /> IV DESCRIPTION — <br /> A. (X) 01 TANK t ) 02 OTHER: CONTAINER NUMBER <br /> B. MANUFACTURER (IF APPROPRIATE): QC�p YEAR MFG:"8 8 C. YEAR INSTALLED 8 8 t D UNKNOWN <br />` 0. CONTAINER CAPACITY: 10a000 GALLONSt I UNKNOWN E. GOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? P<) 01 YES ( ) 02 NO IF YES CHECk'APFROPRIATE BOX(ES): <br /> ( V 01 UNLEADED t ) 02 REGULAR I .) 03 PREMIUM t ) 04 DIESEL f ) OS WASTE OIL t ) 06 OTHER „ <br /> V CONTAINER CONSTRUCTION . <br /> J' <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( D GAUGE t ) INCHES t I CM l ) UNKNOWN <br /> S. t ) 01 VAULTED'(LOCATED IN AN UNOERGROUI(D VAULT) t X 02.NON—VAULTED ( ) 03 UNKNOWN <br /> C. (X) 02 DOUSLE.WALLED t ) 02 SINGLE WALLED t D '03 LINED <br /> D. t ) 01•:'CARSON-STEEL t ) 02 STAINLESS STEEL (X) 03 FIBERGLASS t ) 04 POLYVINYL CHLORIDE f ) 05'CONCRETE <br /> ( D 06 ALUMINUM t D 07 STEEL CLAD t ) 08 BRONZE t ) 09 COMPOSITE t ) 10 NON-METALLIC <br /> U ) 12-UNKNOWN t D 13 OTHER: <br /> HSC04-070185 <br /> PAGE 1 <br /> L <br />