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STATE ID NUMBER 00000062561001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROU D STORAGE TANK <br /> (M O1 NEW PERMIT ( ) 05 RENEWED PERMIT lvl OTeNtt c)CSED T )o 6 ( ) 09 DELETE FROM FILE (NO FEE) <br /> f 1 02 CONDITIONAL PERMIT ( 106 AMENDED PERMIT '( 7 08 MINOR CHANGE ( 0 SURCHARGE) <br /> I OWNER <br /> NAME(COPPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CHEVRON U.S.A. INC. ( 1 01 FED ( ) 02 STATE f ) 03 LOCAL <br /> STREET ADDRESS CITY STATE IIP <br /> 575 MARKET SAN FRANCISCO CA 94105 <br /> II FACILITY <br /> FACILITY N ME DEALER/FOREMAN/SUPERVISOR <br /> 94054 aO�/ +2.(/f DEVONSHIRE,OOHALD <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 2103 COUNTRY CLUB BLV FRANKLIN <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAgUIN 95204 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 2103 COUNTRY CLUB BLV STOCKTON CA 95204 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-462-2575 (X) 01 GASOLINE STATION f 1 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 6 <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/APEA CODE <br /> MAINTENANCE DISPATCH 415-877-0244 - <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK l ) 04 OTHER: CONTAINER NUMBER <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1964 C. YEAR INSTALLED 1964 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 4000 GALLONS ( 1 UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ChT-O1 YES f ) 02 NO IF YES CHECK APPROPRIATE BOX(ES)-- <br /> (34-01 <br /> OX(ES):(kY01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 0000170 f ) GAUGE f ) INCHES ( ) CM ( ) UNKNOWN <br /> B. t ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED f ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED f ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( ) OS CONCRETE <br /> l ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) OB BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />