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STATE ID NUMBER 00000062811002 <br />APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br />Qf.A1 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br />( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( l 08 MINOR CHANGE (NO SURCHARGE) <br />I OWNER <br />J.AME(COP-r ORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br />;HEVRON U.S.A. INC. ( l 01 FED ( ) 02 STATE ( ) 03 LOCAL <br />>TPEET ADDPESS CITY STATE ZIP <br />i75 MARKET SAN FRANCISCO CA 94105 <br />II FACILITY <br />FACILITY N <br />(X) 01 TANK ( ) 04 OTHER: <br />DEALER./FOREMAN/SUPERVISOR <br />MA�MNA-0:h <br />r --Com g <br />r'dr\ <br />MCCOMB,ROBERT J Opc°rc�l�af <br />STPEET ADDPESS <br />MANUFACTURER (IF APPROPRIATE): <br />NEAREST CROSS STREET <br />301 W. KETTLEMAN LANE <br />INSTALLED <br />LEE <br />CITY <br />CONTAINER CAPACITY: 10000 GALLONS ( ) UNKNOWN <br />COUNTY <br />ZIP <br />LODI <br />F. <br />SAN JOAQUIN <br />95240 <br />M:ILING ADDRESS <br />CITY 7CTA <br />TE <br />ZIP <br />301 W. KETTLEMAN LANE <br />LODI <br />95240 <br />PHONE W/AP.-cA CODE <br />TYPE OF BUSINESS <br />209-368-8614 <br />(X) 01 GASOLINE STATION ( l 02 OTHER <br />NUMBEP. OF CONTAINERS <br />PUPAL AREAS ONLY <br />TOWNSHIP <br />RANGE <br />SECTION <br />4 <br />III 24 HOUR EMERGENCY CONTACT PERSON <br />)AYS: NAME(LA.ST NAME FIRST) AND PHONE W/AP.EA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/A.REA CODE <br />1AINTENANCE DISPATCH 415-877-0244 SQ m (!!, - - <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 ( ) GAUGE ( ) INCHES ( <br />CONTAINER <br />NUMBER <br />_Y,4/ <br />B. <br />MANUFACTURER (IF APPROPRIATE): <br />YEAR MFG: <br />Fc—.YEAR <br />INSTALLED <br />( ) UNKNOWN <br />D. <br />CONTAINER CAPACITY: 10000 GALLONS ( ) UNKNOWN <br />E. DOES THE CONTAINER STORE: ( <br />) 01 WASTE <br />(X) 02 PRODUCT <br />F. <br />DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ?�O1 YES ( ) 02 NO <br />YPl 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL <br />IF YES CHECK <br />( ) 06 OTHER <br />APPROPRIATE BOX(ES): <br />V CONTAINER CONSTRUCTION <br />A. <br />THICKNESS OF PRIMARY <br />CONTAINMENT: 0000370 ( ) GAUGE ( ) INCHES ( <br />) CM ( ) UNKNOWN <br />B. <br />( 101 <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 />( ) <br />( l 12 <br />CARBON STEEL <br />06 ALUMINUM <br />UNKNOWN ( ) <br />( 1 02 STAINLESS STEEL (le 03 FIBERGLASS ( ) 04 <br />f ) 07 STEEL CLAD ( ) 08 BONZE f ) 09 COMPOSITE <br />13 OTHER: <br />POLYVINYL CHLORIDE ( l 05 CONCRETE <br />( ) 10 NON-METALLIC <br />HSC04-070185 (10/18/85) PAGE 1 <br />