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• • STATE ID NUMBER 00000030765003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 01 NEW PERMIT ( l 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(CORPORATI ,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> Ute' v Q L t ) 01 FED ( 1 02 STATE ( 1 03 LOCAL <br /> STREIT ADDRESS (,(r STATE <br /> �_pm <br /> SM <br /> GITY cAC' <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> UNION OIL SS# 6015 INDER SINGH <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 601 EAST KETTLEMAN LN. CHEROKEE LN. <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESS / CITY STATE ZIP <br /> p�(�S/((r (� sem CA "t x0' <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-368-0715 (X) O1 GASOLINE STATION ( l 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLYTOWNSHIP FOE SECTION <br /> 4 <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. UNION OIL CO. 415-%T--32'1 V5-_Z <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( 1 04 OTHER: CONTAINER NUMBER 1�9i5-3�k <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG 1978 C. YEAR INSTALLED 1978 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: -&4NW GALLONS ( 1 UNKNOWN E. DOES THE CONTAINER STORE: ( l 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 /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL ( l 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 (X) 02 SINGLE WALLED ( l 03 LINED <br /> D. (X) 01 CARBON STEEL ( l 02 STAINLESS STEEL t } 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD t T 08 BRONZE ( ) 09 COMPOSITE ( l 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> 0 0 <br />