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STATE ID NUMBER <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( 1 01 NEN PERMIT 1 ) 05 RENEWED PERMIT ( 1 07 TANK CLOSED 1 1 09 DELETE FROM FILE (NO FEE) <br /> I 1 02 CONDITIONAL PERMIT 1 ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPORATTON.INCIVIOUAL OR PUBLIC AGENCY) t PUBLIC AGENCY ONLY <br /> Union Oil C&Vnrnny of 641ifornla A dbg �J FJOGAI.r I ) 01 FED ( 1 02 STATE I ) 03 LOCAL <br /> STREET AODRQSS CITY SATGA ZIP2175, N. California CI A <br /> !)gG <br /> II FACILITY <br /> FACILITY NAME DEALER/FCPEMENISUPEPVISOP <br /> STREET ADOPESS NEAREST CROSS STPEET <br /> CITY <br /> COUNTY ZIP <br /> MAILING ADDRESS CITY STATE ZIP <br /> PHON! W/APEA CODE TYPE OF BUSINESS ) <br /> - - ( ) 01 GASOLINE STATION 1 ) 02 OTHER <br /> HUMBER OF CONTAINEFS PUPAL AREAS ONLY : TOWNSHIP PAHGE SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAM,E(LAST NAME FIRST) AND PHONE W/APEA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/APEA CODE <br /> He Far lana t 12. L_ . {415j 945 -7&760 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. ( 1 01 TAttK ( 1 02 OTHER: CONTAINER NUMBER <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED f 1 UNKNOWN <br /> D. CONTAINER CAPACITY: GALLONS 1 1 UNKNOWN E. DOES THE CONTAINER STORE: ( 1 01 WASTE l 1 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( 1 01 YES l 1 02 NO IF YES CHECK APPROPRIATE BO%IESI: <br /> 1 1 <br /> 01 UNLEADED f 1 02 REGULAR 1 1 03 PREMIUM ( ) 04 DIESEL ( 1 05 WASTE OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) lHCHES ( 1 CM 1 1 UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNOERGROUNO VAULT) l 1 02 NON-VAULTEO 1 ) 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED ( 1 02 SINGLE WALLED ( 1 03 LINED <br /> D. 1 1 01 CARBON STEEL l ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE l 1 05 CONCRETE <br /> ( ) 06 ALUMINUM 1 1 07 STEEL CLAD f 1 08 BRONZE 1 1 09 COMPOSITE ( 1 10 NON-METALLIC <br /> 1 1 12 UNKNOWN l 1 13 OTHER: <br /> SC04-070185 PAGE 1 <br />