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STATE ID NV(ADER <br /> J . <br /> APPLICATION FOR PERMIT TO OP"ATE UNDERGROUND STO GE DANK <br /> t ) 01 NEN PERMIT ( ) 05 RENEWED PERMIT t a 07 TANK CLOSED i 09 OEI.E E ,FROM FILE (NO FEE) <br /> _1 <br /> I ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT t D 08 MINOR CHANGE (NO SURCHARGE) , <br /> I OWNER _ <br /> NAME(COPPORATION.INDIVIDUAL OR PU5LIC AGENCY) Fptll <br /> LIC AGENCY ONLY <br /> Desert: Petroleum 01 FLO t 102 STATE t ) 03 LOCAL— <br />�STREET ADORES S CITY STATE y). ZIP. <br /> P_O. Bax 1601 Oxnard CA 93032 <br /> II FACILIT.Y.. i <br /> FACILITY NAME DEALER/FOPEMENISUPERVISOR <br /> Casco -Station #787 i <br />(STREET AOD$ESS NEAREST CROSS STREET <br /> 950 W. 11th Co6lid e <br /> CITY COUNTY 4IP <br /> TzacySin JFjgune 95386 <br /> MAILING ADOPESS CITY STATE ZIP <br /> 4 <br /> 95.0 W. 11th. Trac <br /> — ) <br /> PHONE "CEA COOS TYPE OF BUSINESS <br /> 209 836 9910 tX) OB GASOLINE STATION t ) 02 OTHER <br />(NUMBER OF CONTAINERS RURAL AREAS ONLYTOWNSHIP PANGS S�CCTIO14 <br /> It One (1) <br /> III. 24s NOUR 'EMERGENCY. CONTACT PERSON <br /> CDAYS: NAPIE(LAST NAME FIPSTI AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA COOL <br /> John Rutherford 805-644-6784 Walton �ngin - <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM F®'R * EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TAM f D 02 OTHER: CONTAIIIER NUMBER <br /> B. MANUFACTURER (IF APPROPRIATE): OC YEAR MFG:- 8 C. YEAR INSTALLED 8 8 ( ) UNKNOWN <br /> L0. CONTAINER CAPACITY: 10x00 0 GALLONS ( ) UNKNOWN JE. ODES THE CONTAINER STORE: ( 101 WASTE (X) 02 PRODUCT <br /> IF. DOES THE CONTAIIIER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? K) 01 YES t 102 NO IF YES CHECK APPROPRIATE BOX(ES): <br />'t 4 01 UNLEADED 02 REGULAR I ) 03 PREMIUM t ) 04 DIESEL t ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION • <br /> J' <br /> A. THICKNESS OF PRIMARY CONTAINMENT: t ) GAUGE ( D INCHES ( D CM ( ) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) t X 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. (X) 01 OOUBLE.WALLED t D 02 SINGLE WALLED t ) 03 LINED <br /> D. t 101 CARBON STEEL ( ) 02 STAINLESS STEEL (X) 03 FIBERGLASS ( ) 04 POLYVINYL CHLOR%DE ( D, 05°CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD t ) 08 BRONZE ( ) 09 COMPOSITE t ) 10 NON-METALLIC <br /> t ) 12•Ut(KNOWN ( ) 13 OTHER: <br />)iSC04-070185 <br /> PAGE 1 <br /> P <br />