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• • STATE ID NUMBER 00000018453003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> (XJ <br /> 01 NEW PERMIT ( 7 05 RENEWED PERMIT (X) 07 TANK CLO5 64 0l ( ) 09 DELETE FROM FILE (NO FEE) <br /> 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( 1 0 CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAM,E(CORPORATION,ZNDIVIOUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> ENERGY PETROLEUM INC. ( ) 01 FED ( ) 02 STATE f ) 03 LOCAL <br /> STREET ADDRESS v CITY STATE ZIP <br /> PORT ROAD 91•-1T1'�fj STOCKTON CA. 95203 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> ENERGY PETROLEUM INC. <br /> STREET ADDRESS NEAREST CROSS STREET <br /> PORT ROAD e21 A ?1. (7 <br /> CITY COUNTY ZIP <br /> STOCKTON - SAN JOAQUIN 95203 <br /> MAILING ADDRESS CITYSTATE ZIP <br /> P.O. BOX 744 STOCKTON CA 95201 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-464-4886 ( ) 01 GASOLINE STATION (X) 02 OTHER WHOLESALE <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 4 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FI ST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> ALARM SYSTEM 209-464-4886 SAME -14y,_ <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 3 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1975 ( 1 UNKNOWN <br /> D. CONTAINER CAPACITY: 12000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (XI 01 YES ( 1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> (X) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE 1 ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( )) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED f ) 03 LINED <br /> D. f ., 01 CARBON STEEL f 7 02 STAINLESS STEEL ( l 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> T ( ) 06 ALUMINUM f ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> 0H 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> i <br />