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STATE ID NUMBER 00000014862003 <br />APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br />Li 01 NEW PERMIT ( ) OS RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br />02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br />I OWNER <br />NAME(CORPORATION,INDIVI UAL OR PUBLI AGENCY) <br />PUBLIC AGENCY ONLY <br />WESTCRN XHLAND OIL COQ <br />( ) 01 FED i ) 02 STATE ( ) 03 LOCAL <br />STREET ADDRESS <br />CITY <br />STATE <br />FZ951PZo <br />1210 E. HAMMER LN. <br />STOCKTON <br />CA <br />JE. DOES THE CONTAINER STORE: ( <br />II FACILITY <br />FACILITY NAME <br />(X) 01 TANK ( ) 04 OTHER: <br />DEALER/FOREMAN/SUPERVISO <br />CONTAINER NUMBER 3 <br />HAMMER LANE BEACON <br />MANUFACTURER (IF APPROPRIATE): ARROW <br />9Pf�' <br />(� <br />STREET ADDRESS <br />D. <br />NEAREST CROSS STREET <br />JE. DOES THE CONTAINER STORE: ( <br />1210 E. HAMMER LN <br />F. <br />KATHLEEN <br />IF YES CHECK APPROPRIATE BOX(ES): <br />( ) 06 OTHER <br />CITY <br />D. <br />COUNTY <br />01 <br />) <br />12 <br />ZIP <br />STOCKTON <br />) 03 FIBERGLASS ( ) 04 <br />BRONZE ( ) 09 COMPOSITE <br />SAN JOAQUIN <br />95210 <br />MAILING ADDRESS <br />CITY <br />STATE <br />ZIP <br />1210 E. HAMMER LN <br />STOCKTON <br />CA <br />95210 <br />PHONE W/AREA CODE <br />TYPE OF BUSINESS <br />209-477 +1436- 31r <br />(X) O1 GASOLINE STATION ( ) 02 OTHER <br />NUMBER OF CONTAINERS <br />P.AL AREAS ONLY <br />FRU <br />NSHIP <br />r <br />RANGE <br />SECTION <br />4 <br />III 24 HOUR EMERGENCY CONTACT PERSON <br />DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(IAST NAME FIRST) AND PHONE W/AREA CODE <br />ar�NCE ""E -R 209-4"-rt'36 209 -9s2 --7m / <br />COMPLETE THE FOLLOWING ON A SEPAR TE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. <br />(X) 01 TANK ( ) 04 OTHER: <br />CONTAINMENT: 1/4 <br />CONTAINER NUMBER 3 <br />B. <br />MANUFACTURER (IF APPROPRIATE): ARROW <br />YEAR MFG: 1979 <br />C. <br />YEAR INSTALLED 1980 ( ) UNKNOWN <br />D. <br />CONTAINER CAPACITY: 10000 GALLONS [ ) UNKNOWN <br />JE. DOES THE CONTAINER STORE: ( <br />) 01 WASTE (X) 02 PRODUCT <br />F. <br />DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO <br />( ) 01 UNLEADED ( ) 02 REGULAR (X) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL <br />IF YES CHECK APPROPRIATE BOX(ES): <br />( ) 06 OTHER <br />V CONTAINER CONSTRUCTION <br />A. <br />THICKNESS OF PRIMARY <br />CONTAINMENT: 1/4 <br />( ) GAUGE (X) INCHES ( <br />) CM ( ) UNKNOWN <br />B. <br />( ) <br />01 <br />VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON -VAULTED ( <br />) 03 UNKNOWN <br />C. <br />( l <br />01 <br />DOUBLE WALLED <br />(X) 02 SINGLE WALLED ( <br />l 03 LINED <br />D. <br />(X) <br />( <br />( l <br />01 <br />) <br />12 <br />CARBON STEEL <br />06 ALUMINUM <br />UNKNOWN ( ) <br />( ) 02 STAINLESS STEEL ( <br />( ) 07 STEEL CLAD ( ) 08 <br />13 OTHER: <br />) 03 FIBERGLASS ( ) 04 <br />BRONZE ( ) 09 COMPOSITE <br />POLYVINYL CHLORIDE ( ) 05 CONCRETE <br />( l 10 NON-METALLIC <br />HSC04-070185 (10/18/85) <br />PAGE 1 <br />