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STATE ID NUMBER 00000062561006 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> IkT 01 NEW PERMIT ( 1 05 RENEWED PERMIT 07 TAM( CLOSED ,0 !� rD ( 1 09 DELETE FROM FILE (NO FEE) <br /> ( ] 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 0808 MIN�NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIOUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CHEVRON U.S.A. INC. ( ] 01 FED ( ) 02 STATE ( 7 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 575 MARKET SAh FRANCISCO CA 94105 <br /> II FACILITY <br /> FACILITYAME DEALER/FOREMAN/SUPERVISOR <br /> 94054 on/S V t- DEVONSHIRE.DONALD <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 2103 COUNTRY CLUB BLV FRANKLIN <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95204 <br /> MAILING AODFESS CITY STATE ZIP <br /> 2103 COUNTRY CLUB BLV STOCKTON CA 95204 <br /> PHONE W/AREA CODE TYPEOF BUSINESS <br /> 209-462-2575 (X) 01 GASOLINE STATION f ) 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/ARCA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA 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 ( ) 04 OTHER: CONTAINER NUMBER 6 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1964 C. YEAR INSTALLED 1964 ( 1 UNKNOWN <br /> D. CONTAINER CAPACITY: 550 GALLONS ( l UNKNOWN E. DOES THE CONTAINER STORE: IX) 01 WASTE ( ) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (?C{ 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> [ 1 01 UNLEADED ( 7 02 REGULAR ( 1 03 PREMIUM ( ) 04 DIESEL (<05 WASTE OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 0000100 f ) GAUGE f 1 INCHES ( ) CM ( 1 UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ] 03 FIBERGLASS ( ] 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM f ) 07 STEEL CLAD f ) 08 BRONZE ( 1 09 COMPOSITE [ 1 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> KSC04-070185 (10/18/85) PAGE 1 <br />