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�' '"04 STATE ID NUMBER 00000019587002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> (kf 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 /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CHEVRON U.S.A. INC. ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 575 MARKET ST SAN FRANCISCO CA 94105 <br /> II FACILITY <br /> FACILITY NAME ` 60"44v. <br /> ' DEALER/FOREMAN/SUPERVISOR <br /> I ouiro- 60"4 v. �IlC-V 1�o ZMAK, JOHN W. <br /> STREET ADDRESS `/ NEAREST CROSS STREET <br /> H•EGHWAY-34-R-88- 13-:53& p9-(,(f �D ST. HWY E88 <br /> CITY COUNTY ZIP <br /> LOCKEFORD SAN JOAQUIN 95237 <br /> MAILIN ADDRESS CITY STATE ZIP <br /> P.O. B( 97 LOCKEFORD CA 95237 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-727-9962 (%l 01 GASOLINE STATION f 1 02 OTHER <br /> NUMBER.; C NTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <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/AREA CODE <br /> ZMAK, JOHN 209-727-9962 MAINTENANC€ DISPATCH 415-877-0244 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( 7 04 OTHER: CONTAINER NUMBER 2 <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: 1968 C. YEAR INSTALLED 1968 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 5000 GALLONS f 7 UNKNOWN E. DOES THE CONTAINER STORE: ( 1 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? 4X1 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( l 01 UNLEADED ( ) 02 REGULAR (X) 03 PR MIUM ( ) 04 DIESEL ( 1 05 WASTE OIL ( 7 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> e <br /> A. THICKNESS OF PRIMARY CONTAINMENT: .250 ( ) GAUGE (X) INCHES ( 1 CM ( 1 UNKNOWN <br /> S. ( 7 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 ( 1 02 STAINLESS STEEL ( 103 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE f 7 05 CONCRETE <br /> f ) 06 ALUMINUM [ l 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( 1 10 NON-METALLIC <br /> ' ( ] 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />