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• • STATE ID NUMBER 00000004568001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> f7G O1 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( 1 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPOPATION,INDIVID/UAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> WNS011"OSC^C9. l., ( 1 01 FED ( ) 02 STATE ( 1 03 LOCAL <br /> F—� <br /> STREET ADDRESS <br /> } �•.__-_ __ _ __ D CITY STATE iZP <br /> 'fes CA 943t}9i)/ <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> UNION OIL SSK 2859 ALBERT R. GARIBALDI <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1665 PACIFIC AVE. WALNUT <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95204 <br /> MAILING ADDRESS ���� A CITY STATE ZIP p. <br /> 1�•dl7�! I� 0,41ir G V• �lT1c �� SiB81f?0F} CA 95244! s 6 <br /> PHONE W/APE.A CODE TYPE OF BUSINESS <br /> 209-948-4793 (X) 01 GASOLINE STATION ( ] 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE 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 /> JAURIGUI, L.J. 415-956-96C@ 9cFs- UNION OIL CO. 415-563-9322 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK f 1 04 OTHER: CONTAINER NUMBER zo»-}-1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1967 C. YEAR INSTALLED 1967 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: a <br /> GALLONS f 7 UNKNOWN E. DOES THE CONTAINER STORE: ( 7 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> (X) 01 UNLEADED f ] 02 REGULAR ( ) 03 PREMIUM ( 1 04 DIESEL ( 1 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> p <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 107 STEEL CLAD ( ) 08 BRONZE ( 7 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( 1 12 UNKNOWN f ) 13 OTHER: <br /> HSC04-070185 (10/18/85) <br /> PAGE 1 <br />