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0 ti` <br /> ion <br /> STATE ID NUMBER 00000036048002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> { ) 01 NEW PERMIT ( ) 05 RENEWED PERMIT (Xj' 07 TANK CLOSED (f`1 09 DELETE FROM FILE (NO FEE) <br /> ( 1 02 CONDITIONAL PERMIT { 1 06 AMENDED PERMIT { ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> N4ME(CCPPCPA7ION.IN0lVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CHASE CHEVROLET CO. ( ) 01 FED f ) 02 STATE ( ) 03 LOCAL <br /> STREET .L.DDFESS �17 _�]STAT€ ZIP <br /> 423 N MADI50N CA 95201 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> CHASE CHEVROLET CO BILL CHASE GREG CAMPIGLI <br /> STREET ADDPESS NEAREST CROSS STREET <br /> 423 N MADISON FREMONT <br /> CITY COUNTY ZIP <br /> STOCKTCN SAN JOAQUIN 95201 <br /> MAILING ADDRESS TC17Y STATE ZIP <br /> P.O. BOX1969 CKTON CA 95201 <br /> PHONE W/APEA CODE TYPE OF BUSINESS <br /> 209-948-4444 ( ) 01 GASOLINE STATION (X) 02 OTHER DEALERSHIP <br /> NU:'3ZP OF CONTAINERS PUPAL APEAS ONLY TOWNSHIP RANGE ECTION <br /> 6 S <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 /> CAMPIGLI GREG 209-94&- 444 3 BOB PERALTA 209-474-7552 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER' CONTAINER NUMBER 0000000001 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 5000 GALLONS (X) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES (X1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( 1 04 DIESEL { ] 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) f ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( ) 03 LINED <br /> D. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( l 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( 1 08 BRONZE ( ) 09 COMPOSITE f ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER; <br /> HSC04-070185 (10/18/85) PAGE I <br />