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STATE ID UMBER 00000009414004 <br /> APPLICATION FOR PERMIT TO O /RATE UNDERGROUND STOR E TANK <br /> ( l 01 NEW PERMIT ( ) 05 RENEWED PERMIT ) 07 TANK CLOSED ( V09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> DESERT PETROLEUM, INC. t ) 01 FED ( Y 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE�Zlp <br /> POST OFFICE BOX 1661 OXHARD CA032 <br /> II FACILITY <br /> FACIrLI'TY NAME DEALER/FOREMAN/SUPERVISOR <br /> GASCO SERVICE STATION #787 ARCHULETA, NEDDIE <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 950 WEST 11TH STREET COOLIDGE AVE <br /> CITY COUNTY ZIP <br /> TRACT( SAN JOAQUIN 95376 <br /> MAILING ADDRESS CITY JCTA4 <br /> TE ZIP <br /> POST OFFICE BOX 1601 OXNARD 93032 <br /> PHONE W/AP.EA CODE TYPE OF BUSINESS <br /> 209-836-9910 (X) 01 GASOLINE STATION t ) 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 4 N/A N/A N/A <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 /> DESERT PETROLEUM 415-574-7016 ARCHULETA, NEDDIE 415-490-7365 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTIOhI <br /> A. (X) 01 TANK ( l 04 OTHER: CONTAINER NUMBER #4 <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 280 GALLONS ( ) UNKNOWN JE. DOES THE CONTAINER STORE: (X) 01 WASTE ( ) 02 'PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL 4R WASTE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> t ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM' ( ) 04 DIESEL (X) 05 WASTE OIL t ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> to <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1/4 ( ) GAUGE (X) INCHES ( ) CM t J 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 q -I 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS E ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> { ) 06 ALUMINUM ( D 07 STEEL CLAD ( ) 08 BRONZE t ) 09 COMPOSITE t ) 30 NON-METALLIC <br /> # J 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/853 PAGE I <br />