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FACILITY NAME <br />(X) 01 TANK t ) 04 OTHER: <br />DEALER/FOREMAN/SUPERVISOR <br />CONTAINER <br />BEACON STATION 0 502 <br />B. <br />EARL SALE <br />STATE ID NUMBER 00000042271002 <br />APPLICATION <br />FOR PERMIT TO <br />OPERATE UNDERGROUND STORAGE TANK <br />( 01 NEW PERMIT t D <br />05 RENEWED PERMIT <br />t 107 TANK CLOSED <br />t } 09 DELETE FROM FILE (NO FEE). <br />02 CONDITIONAL PERMIT ( } <br />06 AMENDED PERMIT <br />t ) 08 MINOR CHANGE <br />(NO SURCHARGE) <br />ZIP <br />LODZ <br />I OWNER <br />95240 <br />MAILING ADDRESS <br />NAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) <br />CITY <br />STATE <br />PUBLIC AGENCY ONLY <br />BEACON OIL COMPANY <br />HANFORD <br />CA <br />( } O1 FED ( ) 02 STATE t ) 03 LOCAL <br />STREET ADDRESS <br />TYPE OF BUSINESS <br />CITY <br />209-582-0241 <br />STATE <br />ZIP <br />525 W. THIRD STREET <br />NUMBER OF CONTAINERS <br />PUP, .AL AREAS ONLY <br />HANFORD <br />RANGE <br />CA <br />93230 <br />'II FACILITY <br />FACILITY NAME <br />(X) 01 TANK t ) 04 OTHER: <br />DEALER/FOREMAN/SUPERVISOR <br />CONTAINER <br />BEACON STATION 0 502 <br />B. <br />EARL SALE <br />YEAR MFG: <br />STREET ADDRESS <br />YEAR INSTALLED 1964 t ) UNKNOWN <br />NEAREST CROSS STREET <br />CONTAINER CAPACITY: 12000 GALLONS ( l UNKNOWN <br />35 NORTH CHEROKEE LANE <br />) 01 WASTE (X) 02 PRODUCT <br />ELM STREET <br />DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO <br />( ) 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( <br />CITY <br />COUNTY <br />ZIP <br />LODZ <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 />PUP, .AL AREAS ONLY <br />TOWNSHIP <br />RANGE <br />FEOTION <br />3 <br />III 24 HOUR EMERGENCY CONTACT PERSON <br />DAYS: NAME(LAST NAM! FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br />MCCUTCHEN: JIM 209-582-0241SHIFT SUPERVISOR 209-582-0246 <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. <br />(X) 01 TANK t ) 04 OTHER: <br />t D GAUGE (X) INCHES ( <br />CONTAINER <br />NUMBER E <br />B. <br />MANUFACTURER (IF APPROPRIATE): <br />YEAR MFG: <br />C. <br />YEAR INSTALLED 1964 t ) UNKNOWN <br />D. <br />CONTAINER CAPACITY: 12000 GALLONS ( l UNKNOWN <br />E. DOES THE CONTAINER STORE: ( <br />) 01 WASTE (X) 02 PRODUCT <br />F. <br />DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO <br />( ) 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( ) 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 />t D GAUGE (X) INCHES ( <br />) CM t ? UNKNOWN <br />B. <br />( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON -VAULTED t <br />) 03 UNKNOWN <br />C. <br />( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED t <br />) 03 LINED <br />D. <br />(X) 01 CARBON STEEL t D 02 STAINLESS STEEL ( <br />) 06 ALUMINUM E ) 07 STEEL CLAD ( 108 <br />( D 12 UNKNOWN ( ) 13 OTHER <br />) 03 FIBERGLASS t 104 <br />BRONZE ( l 09 COMPOSITE <br />POLYVINYL CHLORIDE ( l 05 CONCRETE <br />( D 10 NON-METALLIC <br />HSC04-070185 (10/18/85) <br />r <br />PAGE i <br />