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• • STATE I0 NUMBER 00000062887003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> �i NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED <br /> ( ) 02 CONDITIONAL PERMIT ( 7 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE)) 09 DELETE FROM FILE (NO FEE) <br /> I OWNER <br /> NAME(COR.PORATION.INDIVIDUAL OR PUBLIC AGENCY) <br /> CHEVRON U.S.A. INC. PUBLIC AGENCY ONLY <br /> ( ) 01 FED ( ) 02 STATE ( 1 03 LOCAL <br /> SiPEET ADDRESS <br /> 575 MARKET CITY STATE ZIP <br /> SAN FRANCISCO CA 94105 <br /> II FACILITY <br /> FACILITY N E <br /> fig. c hDEALER/FOREMAN/SUPERVISOR <br /> 1. (,',(/('Q PARKS BRAD C ) Q <br /> STREET ADOPESS <br /> 5608 N. PERSHING NEAREST CROSS STREET <br /> ROBINHOOD <br /> CITY <br /> STOCKTON COUNTY IIP <br /> SAN JOAQUIN 95207 <br /> MA:LING ADDRESS CITY <br /> 5608 N. PERSHING STATE IIP <br /> STO <br /> CKTONN CA 95207 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-478-3287 (X) 01 GASOLINE STATION ( 102 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP .RANGE <br /> 4 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 /> 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 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1967 C. YEAR INSTALLED 1967 f ) UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS f 1 UNKNOWN E. DOES THE CONTAINER STORE: ( 101 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ?."O1 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> (� 01 UNLEADED ( 7 02 REGULAR f ) 03 PREMIUM f ) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> F(X) <br /> NESS OF PRIMARY CONTAINMENT: 0000250 ( ) GAUGE ( 1 INCHES f 1 CM ( ) UNKNOWN <br /> 1 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> 1 DOUBLE WALLED fX) 02 SINGLE WALLED f ) 03 LINED <br /> 1 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE f 1 05 CONCRETE <br /> 06 ALUMINUM f ) 07 STEEL CLAD ( ) 08 BRONZE ( 1 09 COMPOSITE ( 1 10 NON-METALLIC <br /> 2 UNKNOWN f 1 13 OTHER: <br /> HSC04-070185 (10/18/85) <br /> PAGE 1 <br />