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STATE ID NUMBER <br />APPLICATION ^FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br />(X) 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br />( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 04 MINOR CHANGE (NO SURCHARGE) <br />I OWNER <br />NAME(COPPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br />Regal Stations, Inc. d D 01 FED ( ) 02 STATE ( J 03 LOCAL <br />STREET ADDRESS CITY STATE ZIP <br />.1765 Challenge Way Sacramento Ca. 95815 <br />II FACILITY <br />FACILITY NAME <br />(X) 01 TANK t ) 02 <br />DEALER/FCREMEN/SUPERVISOR. <br />Regal Station 4605 <br />CONTAINER NUMBER 60 5 -U1 <br />Walt Snelling <br />STR ADDRESS <br />YEAR MFG: UN <br />NEAREST CROSS STREET <br />16E�5 S. El Dorado <br />D. <br />Center Street <br />'Slyockton <br />E. DOES THE <br />cD an Joaquin <br />ZIP 96206 <br />MAILING ADDRESS <br />DOES THE CONTAINER <br />(X) 01 UNLEADED ( <br />CITY <br />STATE <br />ZIP <br />1765 Challenge Way <br />Sacramento <br />Ca. <br />95815 <br />PHONE WiAPE4 CO ,` eaTI <br />TYPE OF BUSINESS <br />Wfel <br />916=923-110 I! -ZGASOLINE <br />STATION ( ) 02 OTHER <br />NUMB R CF O AN', <br />three <br />RURAL <br />AREAS ONLY <br />TOWNSHIP <br />RANGE <br />SECTION <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 />916-921-1100 IWOC Maintenance Dept 1--806-952-5324 <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. <br />(X) 01 TANK t ) 02 <br />OTHER: <br />CONTAINER NUMBER 60 5 -U1 <br />B. <br />MANUFACTURER (IF APPROPRIATE): unknown <br />YEAR MFG: UN <br />C. <br />YEAR INSTALLED (x) UNKNOWN <br />D. <br />CONTAINER CAPACITY: <br />10,000 GALLONS ( D UNKNOWN <br />E. DOES THE <br />CONTAINER STORE: ( <br />) 01 WASTE (X) 02 PRODUCT <br />F. <br />DOES THE CONTAINER <br />(X) 01 UNLEADED ( <br />STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) <br />) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL <br />01 YES ( ) 02 NO <br />( ) 05 WASTE OIL <br />IF YES CHECK APPROPRIATE BOX(ES): <br />( ) 06 OTHER <br />I V CONTAINER CONSTRUCTION <br />A. THICKNESS OF PRIMARY CONTAINMENT: 1/4 ( ) GAUGE (X) INCHES ( ) CM ( ) UNKNOWN <br />B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( A 02 NON -VAULTED ( ) 03 UNKNOWN <br />IC. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br />D. O4 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( D 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br />( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br />( D 12 UNKNOWN ( ) 13 OTHER: <br />I HSC04-070185 <br />PAGE 1 <br />