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r <br />,G4 • STATE ID NUMBER 00000042271001 <br />APPLICATION FOR PERMIT TO OPE ATE UNDERGROUND STORAGE TANK <br />01 NEW PERMIT ( ) 05 RENEWED PERMIT 07 TANK rinRED t. , 09 DELETE FROM FILE (NO FEE) <br />( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHAN (NO SURCHARGE) <br />OWNER <br />NAME(COP.PORATION,INDIVIOUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br />BEACON OIL COMPANY ( ) 01 FED ( ) 02 STATE ( ) 03_LOCAL <br />STREET ADDRESS CITY STATE ZIP <br />525 W. THIRD STREET HANFORD CA 93230 <br />II FACILITY <br />FACILITY NAME <br />(X) 01 TANK ( ) 04 OTHER: <br />DEALER/FOREMAN/SUPERVISOR <br />BEACON STATION (t 502 <br />NUMBER #9VI-1 <br />EARL-3AtE <br />NEAREST CROSS St.CET <br />STREET ADDRESS <br />YEAR MFG: <br />35 NORTH CHEROKEE LANE <br />YEAR INSTALLED 1964 ( ) UNKNOWN <br />ELM STREET <br />CITY <br />l UNKNOWN <br />COUNTY <br />ZIP <br />LODI <br />DOES THE CONTAINER STORE MOTOR VEHICLE <br />( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 <br />SAN JOAQUIN <br />95240 <br />MAILING ADDRESS <br />CITY <br />STATE <br />ZIP <br />525 W. THIRD STREET <br />HANFORD <br />CA <br />93230 <br />PHONE W/AREA CODE <br />TYPE OF BUSINESS <br />209-582-0241 <br />(X) 01 GASOLINE STATION ( ) 02 OTHER <br />NUMBER OF CONTAINERS <br />RURAL AREAS ONLY <br />TOWNSHIP <br />RANGE <br />SECTION <br />3 <br />III 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 />MCCUTCHEN, JIM 209-582-0241 JSHIFT SUPERVISOR 209-582-0246 <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. <br />(X) 01 TANK ( ) 04 OTHER: <br />( ) GAUGE (X) INCHES ( <br />CONTAINER <br />NUMBER #9VI-1 <br />S. <br />MANUFACTURER (IF APPROPRIATE): <br />YEAR MFG: <br />C. <br />YEAR INSTALLED 1964 ( ) UNKNOWN <br />D. <br />CONTAINER CAPACITY: 12000 GALLONS ( <br />l UNKNOWN <br />E. DOES THE CONTAINER STORE: ( <br />l 01 WASTE (X) 02 PRODUCT <br />F. <br />DOES THE CONTAINER STORE MOTOR VEHICLE <br />( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 <br />FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO <br />PREMIUM (X),04 DIESEL ( ) 05 WASTE OIL <br />IF YES CHECK APPROPRIATE BOX(ES): - <br />( ) 06 OTHER <br />V CONTAINER CONSTRUCTION <br />A. <br />THICKNESS OF PRIMARY CONTAINMENT: .025 <br />( ) GAUGE (X) INCHES ( <br />).CM ( ) UNKNOWN <br />B. <br />( ) <br />01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON -VAULTED ( <br />) 03 UNKNOWN <br />C. <br />( l <br />01 DOUBLE WALLED (X) 02 SINGLE WALLED ( <br />l 03 LINED <br />D. <br />(X) <br />( ) <br />01 CARBON STEEL ( ) 02 STAINLESS STEEL ( <br />t ) 06 ALUMINUM ( ) 07 STEEL CLAD ( l 08 <br />12 UNKNOWN ( ) 13 OTHER:' <br />l 03 FIBERGLASS ( ) 04 <br />BRONZE ( l 09 COMPOSITE <br />POLYVINYL CHLORIDE ( ) 05 CONCRETE <br />( )-10 NONMETALLIC <br />HSC04-070188 (10/18/85) <br />PAGE 1 <br />