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i <br /> STATE ID NUMBER 00000018453003 <br /> APPLICATION FOR ' PERMIT ,TO OPERATE UNDERGROUND STORAGE TANK <br /> l� ) 01 NEW PERMIT [ 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED [ 1 09 DELETE FROM FILE (NO FEE) <br /> fd1 02 CONDITIONAL PERMIT t } 06 AMENDED PERMIT, ( ) 08 MINOR CHANGE"(80 SURCHARGE) <br /> - LOWNER rM1 <br /> -i".E(CCP.FOF,ATICN.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> )ERGY PETROLEUM INC. ( ) 01 FED t } 02 STATE ( } 03 LOCAL <br /> 0 1 CITY STATE ZIP <br /> °T AOORESS - <br /> ��t Lfi v 5TOCKTON CA 952 <br /> )41 ROAD e3- 03 <br /> T FACILITY <br /> DEALER/FOREMAN/SUPERVISOR <br /> :ERGY PETROLEUM INC. - <br /> ET AD7P:55 `` F ,x ill NEAREST CROSS STREET ri+ <br /> ROAD c1-4-4- (� <br /> COUNTY zIP <br /> KTON SAN JOA4UIN u 95203 <br /> .ILINO ADDRESS CITY STATE SIP <br /> p, BOX 744 STOCKTON CA'` 95201 <br /> w <br /> W/AREA COLE TYP! OF BUSINESS <br /> ) 464-4886 ( 3 01 GASOLINE STATION (X) 02 OTHER WHOLESALE { <br /> a �!p OF CONTAINERS FURAL AREAS ONLY TOWNSHIP , _. RANGE SELTI^4 •. <br /> 4 <br /> T,j 24 HOUR EMERGENCY CONTACT PERSON <br /> NAnE(L:.$T NA.-.5 FI ST) AND PHONE W/AREA CODE NIGHTS: NAME`(LA$T NAME FIRST) AND PHONE W/AP.EA CCD'_ <br /> SAME - �r <br /> LARM SYSTEM i 204-464-4886 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> V DESCRIPTION <br /> (X1 01 TANK ( 1 04 OTHER q CONTAINER NUMBER 3 <br /> MANUFACTURER (IF APPROPRIATE) YEAR MFG C: YEAR INSTALLED 1975 ( 1 UNKNOWN <br /> CONTAINER CAPACITY: 12000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE= l } 01 WASTE (X) 02 PRODUCT <br /> LDOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( 1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> (X) 01 UNLEADED l ) 02 REGULAR ( 103 PREMIUM ( 1 04 DIESEL ( ) 05 WASTE OIL ( 106 OTHER <br /> CONTAINER CONSTRUCTION <br /> THICKNESS OF PRIMARY CONTAINMENT: L ) GAUGE ( 1 INCHES l I CM (XI UNKHOWN <br /> L ) 01 VAULTED (LOCATED IN AN U140ERGROU40 VAULT)' lX) 02 NON-VAULTED a( ) 03 UNKNOWN <br /> : ( ) 01 DOUBLE WALLED t ) 02 SINGLE WALLED ( 103 LINED ' <br /> CARBON STEEL ( ) 02 STAINLESS STEEL ( } 03 FIBERGLASS l ) 04 POLYVINYL CHLORIDE t 1•'05 CONCRETE, <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( } OB BRONZE ( } 09 COMPOSITE ( ) 10 NON-METALLIC <br /> OTHER' <br /> FF ?AGE 1 <br /> iL4-070185 (10/18/85) <br />