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4b 4 <br /> STATE ID NUMBER 00000030765 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> F J 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED (;?09 DELETE FROM FILE (NO FEE) <br /> G ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 06 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COP.PORATIO ,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> O [ ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE �pm <br /> /C�ClCA i� 7P <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 IIP <br /> 1=1-0 -2t CA <br /> PHONE W/APEA CODE TYPE 0 BUSINESS <br /> 209-368-0715 (X) 01 GASOLINE STATION ( l 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> ION <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. 415-956-7600 UNION OIL CO. 415-561-9322 <br /> COMPLETE THE 'FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. ( ) 01 TANK (X) 04 OTHER: SUMP CONTAINER NUMBER 6015-10-1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: GALLONS (X) UNKNOWN E. DOES THE CONTAINER STORE: (X) 01 WASTE ( l 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES (X) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> t l 01 UNLEADED ( L 02 REGULAR ( l 03 PREMIUM ( ) 04 DIESEL ( l 05 WASTE OIL t ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 6 ( ) GAUGE (X) INCHES ( ) CM ( l 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 ( ) 03 LINED <br /> D. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( l 04 POLYVINYL CHLORIDE (X) 05 CONCRETE <br /> f ) 06 ALUMINUM ( l 07 STEEL CLAD ( ) 08 BRONZE C l 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> 0 <br />