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STATE ID NUMBER 00000062849003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 01-e 01 NEW PERMIT f ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED <br /> ( ) 02 CONDITIONAL PERMIT f ) 06 AMENDED PERMIT f ) 08 MINOR CHANGE (NO SURCHARGE)) 09 DELETE FROM FILE (NO FEE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) <br /> CHEVRON U.S.A. INC. PUBLIC AGENCY ONLY <br /> Te"cET ADDRESS ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> S <br /> 575 MARKET CITY STATE ZIP <br /> SAN FRANCISCO CA 94105 <br /> II FACILITY <br /> FACIt <br /> 9615DEALEP:FOREMAN/SUPERVISOR <br /> / 4 II (` C SCHOPP,ROY <br /> STPEE9474 NEAREST CROSS STREET <br /> MORADA LN <br /> CITYCOUNTYSTOCKIIP <br /> SAN- JOAQUIN <br /> 95205 <br /> MAILING ADDRESS <br /> 9474 HWY 99, NORTH CITY STATE ZIP <br /> STOCKTON CA 95205 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-931-9990 (X) O1 GASOLINE STATION ( 7 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE <br /> 5 SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NI GM TS: 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 3 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1966 C. YEAR INSTALLED 1966 ( 1 UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS ( ] UNKNOWN E. DOES THE 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 /> ( ) 01 UNLEADED (>J 02 REGULAR f ) 03 PREMIUM f ) 04 DIESEL ( ) 05 WASTE OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> F(X) <br /> NESS OF PRIMARY CONTAINMENT: 0000250 ( ) GAUGE ( ) INCHES f ) CM ( ) UNKNOWN <br /> 1 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> 1 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> CARBON STEEL ( 1 02 STAINLESS STEEL ( ] 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( l 05 CONCRETE <br /> 06 ALUMINUM ( 1 07 STEEL CLAD ( l 08 BRONZE t ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) <br /> PAGE I <br />