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f <br /> STATE ID NUMBER 00000062578002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> [ 1:14(.7 <br /> EW' PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( l 09 DELETE FROM FILE (NO FEE) <br /> 02ONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE 040 SURCHARGE) <br /> I OWN E R <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CHEVRON U.S.A. INC. .( ) 01 FED ( ) 02 STATE t ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 575 MARKET SAN FRANCISCO CA 94105 <br /> II FACILITY A <br /> FACILITY NAME , _ rntA 9 y R�� DEALER/FOREMAN/SUPERVISOR <br /> 44M L o-Kie WooeVrc n PAIGE, KENNETH W <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 236 N. HAM LANE LOCKEFORD <br /> CITY COUNTY ZIP <br /> LORI SAN JOAQUIN 95240 <br /> M.4ILIR3 ADDRESS FLODI <br /> ITFCA <br /> TE ZIP <br /> 236 N. HAM LANE 9524fl <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 20.9-334-2241 (X) 01 GASOLINE STATION ( ) 0.2 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 4 <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 s ck Me - - <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: 1%TCYEAR INSTALLED 1969 t ) UNKNOWN <br /> D. CONTAINER CAPACITY: 5000 GALLONS ( ) UNKNOWN J" E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ?4W1 YES t ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> 1 01 'UNLEADED ( 1 02 REGULAR (3er 03 PREMIUM ( 104 DIESEL [ ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER C"ONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 0000250 t l GAUGE ( ) INCHES ( ) CM f l UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN. AN UNDERGROUND VAULT) (X) 02 NON-VAULTED t l 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 0:2 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS [ ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( 1 10 NON-METALLIC <br /> 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />