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0 <br /> STATE 10 <br /> N <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGEoDa0006zaa9oo5 <br /> UMBER <br /> 01 NEW PERMIT f 1 05 RENEWED PERMIT TANK <br /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT �07 TANK CLOSED <br /> ( 7 08 MINOR CHANGE (NO SURCHARGE)) 09 DELETE FROM FILE (NO FEEL <br /> I OWNER <br /> NAME(CORPORATION,INDIVIOUAL OR PUBLIC AGENCY) <br /> CHEVRON U.S.A. INC. PUBLIC AGENCZ <br /> STREET ADDRESS ( ) O1 FED STATE ( ) 03 LOCAL <br /> 575 MARKET CITYSAN FRANCISCO ZIP <br /> 94105 <br /> II FACILITY <br /> FACILITY NAME <br /> 96155. 5C 605 �I DEALER/FOREMAN/SUPERVISOR <br /> (�CI�I-UYI SQ-�vl SCHOPP,ROY <br /> STREET ADDRESS <br /> 9474 HWY 99, NORTH NEAREST CROSS STREET <br /> CITY MORAOA LN <br /> STOCKTON COUNTY <br /> SAN JOAQUIN ZIP <br /> MAILING ADDRESS 95205 <br /> 9474 HWY 99, NORTH CITY <br /> STOCKTON STATE ZIP <br /> PHONE W/AREA CODE CA 95205 <br /> 209-931-9990 TYPE OF BUSINESS <br /> (X) 01 GASOLINE STATION ( ) 02 OTHER <br /> NUMBER OF CONTAINERS <br /> 5 RURAL AREAS ONLY TOWNSHIP <br /> RANGE SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> MAINTENANCE DISPATCH 415-877-0244 NIGHTS: NAME <br /> NAME FIRST) AND PHONE W/AREA COON <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK f l 04 OTHER: <br /> CONTAINER NUMBER 5 <br /> B. MANUFACTURER (IF APPROPRIATE): <br /> YEAR MFG: 1966 C. YEAR INSTALLED 1966 ( 7 UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 GALLONS f ) UNKNOWN E. ODES THE CONTAINER STORE: (X) 01 WASTE ( ) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES O0' 02 NO If YES CHECK.APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL [� 06 OTHER�� 0l <br /> V CONTAINER CONSTRUCTION '#Z <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 0000130 ( ) GAUGE ( ) INCHES ( ) CM ( ) UNKNOWN <br /> e• ( ) 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 /> 0. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS [ l 04 POLYVINYL CHLORIDE ( 7 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( 1 08 BRONZE ( 1 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> iSC04-070185 (10/18/85) <br /> PAGE 1 <br /> 16 <br />