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STATE ID NUMBER 00000019587003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> O(fO1 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> f ) 02 CONDITIONAL PERMIT f 1 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 f ) 02 STATE ( 1 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 575 MARKET ST SAN FRANCISCO CA 94105 <br /> II FACILITY <br /> FACILITY NAME (T- /' DEALER/FOREMAN/SUPERVISOR <br /> rte- Vouj&%- Comni ` Cke-✓ro i_\ ZMAK, JOHN W. <br /> STREET ADDRESS ``II NEAREST CROSS STREET <br /> mea 1333(0 �. 1> Fr� ST. HWY4188'(Z <br /> CITY COUNTY ZIP <br /> LOCKEFORO SAN JOAQUIN 95237 <br /> MAILING ADDRESS CITY STATE ZIP <br /> P.O. BW97 LOCKEFORD CA 95237 <br /> PHONE W/AREA CODE TYPEOF DUSI NE SS <br /> 209-727-9962 (X) 01 GASOLINE STATION ( 102 OTHER <br /> NUMBER OF 0NTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 3 <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 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 3 <br /> B. MANUFACTURER (IF APPROPRIAATTE))): UNKNOWN YEAR MFG: 1968 C. YEAR INSTALLED 1968 ( ) UNKNOWN <br /> 0. CONTAINER CAPACITY: GALLONS ( 1 UNKNOWN E. DOES TF(E CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> (X) 01 UNLEADED ( ) 02 REGULAR ( 1 03 PREMIUM ( ) 04 DIESEL ( ) OS WASTE OIL f l 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: .179 [ ) GAUGE (X) INCHES ( ) CM ( ) UNKNOWN <br /> B. f ) 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 ( 1 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 1 07 STEEL CLAD ( 1 08 BRONZE f 1 09 COMPOSITE ( l 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />