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STATE ID NUMBER 00000062811003 <br />APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br />�j.01 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 />4AME(CORPORATICN.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br />;HEVRON U.S.A. INC. ( ) 01 FED ( ) 02 STATE f l 03 LOCAL <br />>TREET ADDRESS CITY STATE ZIP <br />i75 MARKET SAN FRANCISCO CA 94105 <br />II FACILITY <br />C <br />(X) 01 TANK ( ) 04 <br />OTHER= <br />) CM ( ) UNKNOWN <br />CONTAINER <br />NUMBER <br />FACILITY NAME F.f <br />9saft c- � <br />5 <br />keV v- y1 <br />YEAR MFG: <br />DEALER/FOREMAN/SUPERVISOR <br />MCCOMB,ROBERT J, Opp-r'a$,01- <br />YEAR INSTALLED <br />STREET A.CCRESS <br />D. <br />CONTAINER CAPACITY: <br />10000 GALLONS ( l UNKNOWN <br />NEAREST CROSS STREET <br />) 01 WASTE (X) <br />301 W. KETTLEMAN LANE <br />F. <br />DOES THE CONTAINER <br />( ) 01 UNLEADED ( <br />STORE MOTOR VEHE FUEL OR WASTE OIL ? L-)�- O1 YES ( ) 02 NO <br />) 02 REGULAR !.-').03 E,MIUM ( ) 04 DIESEL ( ) 05 WASTE OIL <br />LEE <br />BOX(ES): <br />CITY <br />UNKNOWN ( ) <br />13 OTHER: <br />COUNTY <br />ZIP <br />LODI <br />SAN JOAQUIN <br />95240 <br />MAILING ADDRESS <br />CITY <br />STATE <br />ZIP <br />301 W. KETTLEMAN LANE <br />LODI <br />CA <br />95240 <br />PHONE W!AREA CODE <br />TYPE <br />OF BUSINESS <br />209-368-8614 <br />(X) <br />01 GASOLINE STATION ( ) 02 OTHER <br />NUMBER OF CONTAINERS <br />RURAL AREAS <br />ONLY <br />TOWNSHIP <br />RANGE <br />SECTION <br />4 <br />III 24 HOUR EMERGENCY CONTACT PERSON <br />)AYS: NAME(L.AST NAME FIRST) AND PHONE W/APER CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br />1AINTENANCE DISPATCH 415-877-0244 Sa me- - - <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. <br />(X) 01 TANK ( ) 04 <br />OTHER= <br />) CM ( ) UNKNOWN <br />CONTAINER <br />NUMBER <br />< <br />B. <br />MANUFACTURER (IF APPROPRIATE): <br />YEAR MFG: <br />C. <br />YEAR INSTALLED <br />19:3( ) UNKNOWN <br />D. <br />CONTAINER CAPACITY: <br />10000 GALLONS ( l UNKNOWN <br />E. DOES THE CONTAINER STORE: ( <br />) 01 WASTE (X) <br />02 PRODUCT <br />F. <br />DOES THE CONTAINER <br />( ) 01 UNLEADED ( <br />STORE MOTOR VEHE FUEL OR WASTE OIL ? L-)�- O1 YES ( ) 02 NO <br />) 02 REGULAR !.-').03 E,MIUM ( ) 04 DIESEL ( ) 05 WASTE OIL <br />IF YES CHECK APPROPRIATE <br />( ) 06 OTHER <br />BOX(ES): <br />v r_nNTATNFR CONSTRUCTION <br />A. <br />THICKNESS OF PRIMARY <br />CONTAINMENT: 0000370 ( ) GAUGE ( ) INCHES ( <br />) CM ( ) UNKNOWN <br />B. <br />( l 01 <br />VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON -VAULTED ( <br />) 03 UNKNOWN <br />C. <br />( ) 01 <br />DOUBLE WALLED <br />(X) 02 SINGLE WALLED ( ) 03 LINED <br />D. <br />( ) 01 <br />CARBON STEEL <br />( ) 02 STAINLESS STEEL �03 FIBERGLASS ( ) 04 <br />POLYVINYL CHLORIDE ( l 05 CONCRETE <br />( l <br />06 ALUMINUM <br />( ) 07 STEEL CLAD ( ) 08 BRONZE ( l 09 COMPOSITE <br />( ) 10 NON-METALLIC <br />( ) 12 <br />UNKNOWN ( ) <br />13 OTHER: <br />HSC04-070185 (10/18/85) PAGE 1 <br />