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STATE ID <br /> UMBER <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGENTANK oaoouD6ze49Doz <br /> (�t'f O1 NEW PERMIT ( ) 05 RENEWED PERMIT ( 1 07 TANK CLOSED <br /> f ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( 7 08 MINOR CHANGE (NO SURCHARGE)) U9 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 /> STREET ADDRESS ( ) 01 FED ( ) 02 STATE f ) 03 LOCAL <br /> 575 MARKET CITY STATE: <br /> zip <br /> SAN FRANCISCO <br /> CA 941 94105 <br /> II FACILITY <br /> FACILITY NAME <br /> 96155 _/ /5 I k��ro C�Y_ DEALER/FOREM.AN/SUPERVISOR <br /> L-lv LV(C SCHOPP,ROT <br /> STPEET ADDRESS <br /> 5474 HWY 99, NORTH NEAREST CROSS STREET <br /> MORADA LN <br /> CITY <br /> STOCKTON COUNTY <br /> SAN JOAQUIN ZIP <br /> MAILING ADDRESS 95205 <br /> 9474 HWY 99, NORTH CITY <br /> 570CKTON s7g7E 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 RURAL AREAS ONLY : TOWNSHIP <br /> 5 RANGE SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> MNIGHTS: NAME()AST NAME FIRST) AND <br /> MAINTENANCE DISPATCH 415-677-0244 PHONE W/AREA CODE <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: <br /> CONTAINER NUMBER <br /> B. MANUFACTURER (IF APPROPRIATE): <br /> YEAR MFG: 1966 C. YEAR INSTALLED 1966 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 4000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( 1 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? <br /> .( ) 01 UNLEADED ( ] 02 REGULAR 00 03 PREMIUM ( 7 04 UI€5�0f ]E05 WgSTE20IL fI) YES06 OCHECK APPROPRIATE BOX(ES): <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 0000170 f ) GAUGE f 1 INCH€S ( ) CM ( ) UNKNOWN <br /> 8• ( 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03UNKNOWN <br /> C• ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED f ) 03 LINED <br /> D, fX) 01 CARBON STEEL ( 7 02 STAINLESS STEEL ( 1 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> f ) 06 ALUMINUM ( 1 07 STEEL CLAD ( 7 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN f ) 13 OTHER: <br /> iSC04-070185 (10/18/85) <br /> PAGE 1 <br />