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STATE ID NUMBER 00000062811004 <br />APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br />Q401 NEW PERMIT ( ) 05 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 />LAME(COPPCRATICN.INOIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br />:HEVRON U.S.A. INC. ( ) 01 FED ( ) 02 STATE ( 1 03 LOCAL <br />:T=EET ADDRESS CITY STATE ZIP <br />i75 MARKET SAN FRANCISCO CA 94105 <br />II FACILITY <br />FACILITY NAME <br />S <br />DEALER/FOREMAN/SUPERVISORJ <br />q G is <br />e(rr o i n <br />MCCOMB, ROBERT J <br />STREET ADDPESS <br />MANUFACTURER (IF APPROPRIATE)* <br />NEAREST CROSS STREET <br />301 W. KETTLEMAN LANE <br />YEAR INSTALLED <br />LEE <br />CITY <br />CONTAINER CAPACITY: 10000 GALLONS ( l UNKNOWN <br />COUNTY <br />ZIP <br />LODI <br />F. <br />SAN JOAQUIN <br />95240 <br />MAILING ADDRESS <br />POLYVINYL CHLORIDE ( ) 05 CONCRETE <br />( ) 10 NON-METALLIC <br />CITY" <br />STATE <br />ZIP <br />301 W. KETTLEMAN LANE <br />LODI <br />CA <br />95240 <br />PHONE W/.APER CODE <br />TYPE OF BUSINESS <br />209-368-8614 <br />(X) 01 GASOLINE STATION ( l 02 OTHER <br />NUMBER OF CONTAINEPS <br />PUPAL AREAS ONLYTOWNSHIP <br />RANGE <br />SECTION <br />4 <br />III 24 HOUR EMERGENCY CONTACT PERSON <br />SIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br />AY"S: NAME(LkST NA'",E FIRST) AND PHONE W: AREA CODE N <br />IAINTENANCE DISPATCH 415-877-0244 <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. <br />(X) 01 TANK ( ) 04 OTHER: <br />CONTAINMENT: 0000370 <br />CONTAINER <br />NUMBER <br />-4-".--3 <br />B. <br />MANUFACTURER (IF APPROPRIATE)* <br />YEAR MFG: <br />C. <br />YEAR INSTALLED <br />j" ) UNKNOWN <br />D. <br />CONTAINER CAPACITY: 10000 GALLONS ( l UNKNOWN <br />E. DOES THE CONTAINER STORE: ( <br />) 01 WASTE (X) <br />02 PRODUCT <br />F. <br />DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? 01 YES ( ) 02 NO <br />( ) 01 UNLEADED (� 02 REGULAR f l 03 PREMIUM ( ) 04 DI ( ) 05 WASTE OIL <br />IF YES CHECK APPROPRIATE BOX(ES): <br />( l 06 OTHER <br />V CONTAINER CONSTRUCTION <br />A. <br />THICKNESS OF PRIMARY <br />CONTAINMENT: 0000370 <br />( ) GAUGE ( ) INCHES ( <br />) CM ( ) UNKNOWN <br />B. <br />( 1 01 <br />VAULTED (LOCATED <br />IN AN UNDERGROUND VAULT) (X) 02 NON -VAULTED I <br />) 03 UNKNOWN <br />C. <br />( ) 01 <br />DOUBLE WALLED <br />(X) 02 SINGLE WALLED <br />( ) 03 LINED <br />D. <br />( l 01 <br />( ) <br />( ) 12 <br />CARBON STEEL <br />06 ALUMINUM <br />UNKNOWN ( ) <br />( l 02 STAINLESS STEEL <br />( l 07 STEEL CLAD ( ) <br />13 OTHER: <br />()d'03 FIBERGLASS ( ) 04 <br />08"WONZE ( ) 09 COMPOSITE <br />POLYVINYL CHLORIDE ( ) 05 CONCRETE <br />( ) 10 NON-METALLIC <br />HSC04-070185 (10/18/85) PAGE 1 <br />