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f' <br /> STATE I NUMBER 00000009414003 <br /> APPLICATION FOR PERMIT TO OP ATE UNDERGROUND STO GE TANK <br /> t ) 01 NEW PERMIT ( l 05 RENEWED PERMIT ( l 07 TAMC CLOSED ) 09 DELETE FROM FILE (NO FEE) <br /> E ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( D 08 MINOR CHANGE (NO SURCHARGE): <br /> I OWNER <br /> NAME(CORPOR.ATION,INDSVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> DESERT PETROLEUM, INC. ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> POST OFFICE BOX 1601 OXNARD CA 93032 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOP <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 /> TRACY SAN JOAQUIN 95376 <br /> MAILING ADDRESS CITY FCA <br /> TE ZIP <br /> POST OFFICE BOX 1601 OXNA:RD 93032 <br /> PHONE W/AP.EA CODE TYPE OF BUSINESS <br /> 209-836-9910 (X) 01 GASOLINE STATION ( i 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSITYP RANGE SECTION <br /> 4 A N/A N/A <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(IAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AP,EA 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 DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER #3 <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY 7500 GALLONS t I UNKNOWN JE. DOES THE CONTAINER STORE: f ) 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 /> (X) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( d 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1/4 ( ) GAUGE (X) INCHES ( ) CM ( l UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON—VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 0.1 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. (,X) 01'CARBON STEEL'> ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS f 7 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE E ) 09 COMPOSITE ( ) 10 NON—METALLIC <br /> t ) 12 UNKNOWN ( 4`13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> l . _ <br />