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f <br /> f <br /> STATE 10 NUMBER 00000009414002 <br /> APPLICATION FOR PERMIT TO OPE ATE UNDERGROUND STOR GE TANK <br /> { l 01 NEW PERMIT ( ) 05 RENEWED PERMIT (V07 TANK CLOSED (t/09 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) FP(UB)l <br /> IC AGENCY ONLY <br /> DESERT PETROLEUM, INC. 01 FED ( ) 02 STATE ( l 03 LOCAL <br /> STREET ADDRESS CITY STATE 2IP <br /> POST OFFICE BOX 1601 70XNARD CA 93032 <br /> II FACILITY <br /> FACILITY 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 IIP <br /> TRACY SAN JOAQUIN 95376 <br /> MAILING ADDRESS CITY STATE ZIP <br /> POST OFFICE BOX 1601 OXNARD CA 93032 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-836-9910 (X) 01 GASOLINE STATION t ), 02 OTHER <br /> NUMS,ER 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 415-574-70:16 ARCHULETA, NEDDIE 415-490-7365 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A (X) 01 TANK t l 04 OTHER: CONTAINER NUMBER #2 <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY`: 5000 GALLONS ( ) UNKNOWN JE. DOES THE CONTAINER STORE: t ) 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 t ) 02 REGULAR (X) 03 PREMIUM ( ) 04 DIESEL ( l 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1/4 ( ) GAUGE (X) INCHES ( ) CM t ) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. t } 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. (XI 01 CARBON STEEL f 1 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( l 04 POLYVINYL CHLORIDE ( i 05 CONCRETE <br /> ( ) 06 ALUMINUM t l 07 STEEL CLAD . ( ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> t } 12'UNKNOWN ( ) 13 ;OTHER <br /> HSC04-070185 (10/18/85) PAGE I <br />