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i <br />NUMBERSTATE 10 <br />APPLICATION O. PERMIT t, UNDERGROUND O. <br />t ) 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( .D 09 DELETE FROM FILE (NO FEE) <br />t ) 02 CO)ioITIONAL PERMIT ( ) 06 AMENDED PERMIT' ( ) 00 MINOR CHANGE (NO SURCHARGE) <br />I OWNER <br />NAME(COPPORATION,INCIVIDUAL OR PUBLIC AGEIr{CY) PUBLIC AGENCY ONLY <br />Union ©IJ Gmpp <br />yny pG Gaiifornia , dbg 01 FED 1 ) 02 STATE t D 03 LOCAL <br />STREET ADORES' C%T-Y STATE ZIP <br />2:75 N. Gatifornia Ri l.= 5(riita lo5t> IaLlnut crock cl "1459 Co <br />II FACILITY <br />FACILITY NAME <br />( ) 01 TANK <br />OEALER/FOPEMENISUPERVISOP <br />02 OTHER: <br />STREET ADDRESS <br />CONTAINER NUMBER <br />NEAREST CROSS STREET <br />CITY <br />COUNTY <br />ZIP <br />MAILING ADDRESS <br />MANUFACTURER <br />CITY <br />APPROPRIATE): <br />STATE <br />ZIP <br />PHONE W/AFEA CODE <br />- - <br />TYPE OF BUSINESS ' <br />t ) 01 GASOLINE STATION [ 1 02 OTHER <br />NUMBER OF CONTAINEFS <br />RURAL AREAS ONLY,: <br />TOWNSHIP <br />RANGE <br />SECTION <br />III 24 HOUR EMERGENCY CONTACT PERSON <br />GAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODENIGHTS: NAME(LAST NAME FIRST)ANO PHONE W/AREA CODE <br />Na Far larâ–ºG *5) 945 7&7Co - - <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />!A. <br />( ) 01 TANK <br />( 1 <br />02 OTHER: <br />CONTAINER NUMBER <br />B. <br />MANUFACTURER <br />(IF <br />APPROPRIATE): <br />YEAR MFG: <br />C. YEAR INSTALLED ( ) UNKNOWN <br />D. CONTAINER CAPACITY: GALLONS t ) UNKNOWN JE. DOES THE CONTAINER STORE: ( 1 01 WASTE l ) 02 PRODUCT <br />F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES ( D 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br />( ) 01 UNLEADED t D 02 REGULAR [ ) 03 PREMIUM t D 04 DIESEL t 1 05 WASTE OIL ( ) 06 OTHER <br />V CONTAINER CONSTRUCTION <br />A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES t'1 CM ( ) UNKNOWN <br />B. ( 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NOH -VAULTED t ) 03 UNKNOWN <br />C. ( ) 01 DOUBLE WALLED ( 102 SINGLE WALLED ( 1 03 LINED <br />D. t D 01 CARBON STEEL t ) 02 STAINLESS STEEL t D 03 FIBERGLASS t 1 04 POLYVINYL CHLORIDE ( D 05 CONCRETE <br />t ) 06 ALUMINUM ( ) 07 STEEL CLAD t D 08 BRONZE ( D 09 COMPOSITE ( ) 10 NON-METALLIC <br />t ) 12 UNKNOWN ( D 13 OTHER: <br />SC04-070185 <br />PAGE I <br />