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STATE ID NUMBER 0000006259800'x• <br />APPLICATI.ON FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br />IX,01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TAMC CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br />( } 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br />I OWNER <br />NAME(CORPORATION,:NDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br />CHEVRON U.S.A. INC. ( l 01 FED ( i 02 STATE ( ) 03 LOCAL <br />STREET ADDRESS CITY STATE ZIP <br />575 MARKET SAM FRANCISCO CA 94105 <br />II FACILITY <br />FACILITY NAMEDEALER/FOREMAN/SUPERVISOR9ir2'! <br />(X) 01 TANK ( ) 04 OTHER: <br />( ) GAUGE ( ) INCHES ( <br />CONTAINER NUMBER <br />JUNCO <br />B. <br />FELTON, SHARON 0. <br />YEAR MFG 1973 <br />STREET ADDRESS <br />YEAR INSTALLED 1973 t ) UNKNOWN <br />NEAREST CROSS STREET <br />CONTAINER CAPACITY: 10000 GALLONS ( ) UNKNOWN <br />2905 W. BENJAMIN HOLT <br />) 01 WASTE <br />1-s' P( v Indw%� <br />F. <br />CITY <br />IF YES CHECK <br />( ) 06 OTHER <br />COUNTY <br />ZIP <br />STOCKTON <br />SAN JOAQUIN <br />95207 <br />MAILING ADDRESS <br />CITY <br />STATE <br />ZIP <br />2905 W. BENJAMIN HOLT <br />STOCKTON <br />CA <br />95207 <br />PHONE W/A.REA CODE <br />TYPE OF BUSINESS <br />209-478-5555 <br />(X) 01 GASOLINE STATION ( ) 02 OTHER <br />NUMBER OF CONTAINERS <br />RURAL AREAS ONLY 1TOWNSHIP <br />RANGE <br />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 - - <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. <br />(X) 01 TANK ( ) 04 OTHER: <br />( ) GAUGE ( ) INCHES ( <br />CONTAINER NUMBER <br />3� <br />B. <br />MANUFACTURER (IF APPROPRIATE): <br />YEAR MFG 1973 <br />C. <br />YEAR INSTALLED 1973 t ) UNKNOWN <br />D. <br />CONTAINER CAPACITY: 10000 GALLONS ( ) UNKNOWN <br />E. DOES THE CONTAINER STORE: ( <br />) 01 WASTE <br />(X) 02 PRODUCT <br />F. <br />DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ?Pa 01 YES ( ) 02 NO <br />T 01 UNLEADED (�S'02 REGULAR ( ) 03 PREMIUM ( ) 04 DI SEL ( l 05 WASTE OIL <br />IF YES CHECK <br />( ) 06 OTHER <br />APPROPRIATE BOX(ES): <br />V CONTAINER CONSTRUCTION <br />A. THICKNESS OF PRIMARY <br />CONTAINMENT: 0000250 <br />( ) GAUGE ( ) INCHES ( <br />) CM ( ) UNKNOWN <br />B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON -VAULTED ( <br />) 03 UNKNOWN <br />C. ( ) 01 DOUBLE WALLED <br />(X) 02 SINGLE WALLED ( <br />l 03 LINED <br />D. 1 CARBON STEEL <br />E ) 06 ALUMINUM <br />( l 12 UNKNOWN ( ) <br />( ) 02 STAINLESS STEEL ( <br />( ) 07 STEEL CLAD ( ) 08 <br />13 OTHER: <br />) 03.FIBERGLASS ( ).04 <br />BRONZE ( J 09 COMPOSITE <br />POLYVINYL CHLORIDE ( l 05 CONCRETE <br />( ) 10 NON-METALLIC <br />HSC04-070185 (10/18/85) <br /># It <br />:PAGE 1 <br />