Laserfiche WebLink
Request for Reconsideration (RFR) Form( RFR NO. <br />For SWRCB use only. <br />BUSINESS NAME (FAcnm NAME) <br />FACILITY ID# <br />Chevron #201761` <br />; <br />STREET ADDRESS <br />COUNTY <br />1103 S. Main St. <br />San Joaquin <br />CITY <br />ZIP <br />Manteca <br />95337 <br />EMAIL ADDRESS <br />ppr)vp <br />( 209 ) 9,7_S - <br />NAME 1. OWNER 03. BOTH I & 2 <br />Chevron Products Company/Eric Munns 02.OPERATOR <br />TITLE OF APPLICANT PHONE <br />Retail HES Specialist ( 209) bSo - 112 BZ <br />MAILING ADDRESS ® (MAILING ADDRESS SAME AS FACILITY ADDRESS) <br />PO Box 6004 Attn. HES Permit Desk 1-2375 <br />CITY STATE ZIP CODE <br />San Ramon, CA 94583 <br />EMAIL ADDRESS <br />EMunnsCcDchevron.com <br />Please check reason(s) why you believe that the California State Water Resources Control Board (State Water Board) notification is in <br />error. If you are requesting reconsideration for reasons #1 through #3, documentation is required. If you do not include required <br />documentation, your request for reconsideration application will be considered incomplete and will be returned. Include all <br />supporting documentation you wish the State Water Board to consider when reviewing your request. All information submitted <br />with requests for reconsideration is subject to verification. <br />1. ❑ UST system(s) is permanently closed. (DOCUMENTATION IS REQUIRED.) <br />2. ❑ UST system(s) is exempt from regulation, according to Section 25281(x)(1)(A)-(D) of the Health and Safety Code, <br />or Section 2621 of Title 23 of the California Code of Regulations. For example, certain farm tanks and heating oil tanks are <br />exempt. (DOCUMENTATION IS REQUIRED.) <br />3. ❑✓ Closest component of UST system(s) is greater than 1,000 feet from well head of any public drinking water well. Check <br />applicable reason(s): If the request for reconsideration is based on evidence that the UST system in question is greater than <br />1,000 feet from a public drinking water well, include a demonstration that the well head is more than 1,000 feet <br />from the closest component of the UST system. (DOCUMENTATION IS REQUIRED.) <br />❑ UST facility incorrectly located in Geotracker database. <br />❑ Public drinking water well(s) incorrectly located in Geotracker database. <br />4. E✓ Other(explain): <br />According to Geotracker and Terry Brazell w/SWRCB there is no public drinking water well within 1000' of this facility, <br />NOTE: SUBMITTAL INSTRUCTIONS ON REVERSE SIDE OF THIS FORM <br />RM X t �'.,.,z�.�,<5.� �5✓,k�',.�. .,��,YA <br />`Certification - I certify that the information -provided herein is true. and ucftiraie to the bestof my knowledge."I%nowiagly-submitting a request for:reconsideratioo- + <br />based on false or misleading information may be considered a violation of Health and Safety Code, Section 25299, punishable by fine up to $5000. <br />NAME OF APPLICANT (print) PHONE <br />Chevron, Products Company/Eric Munns (209) 858-1082 <br />SIGNATURE OF APPLICANT DATE <br />— 02-27-08 <br />