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STATE ID NUMBER 00000062598001 <br />APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br />(.�l NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK 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,INCIVZDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br />CHEVRON U.S.A. INC. ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br />STREET ADDRESS CITY STATE ZIP <br />575 MARKET SAN FRANCISCO 6A 94145 <br />II FACILITY <br />C46v <br />ro n <br />( ) GAUGE ( ) INCHES ( ) CM ( ) UNKNOWN <br />CONTAINER <br />NUMBER tib 2. <br />FACILITY NAME <br />Lj,\cnlk, <br />MANUFACTURER (IF APPROPRIATE): <br />YEAR MFG: 1973 <br />C. <br />DEALER/FOREMAN/SUPERVI-SOR <br />9i475 Vi <br />I lac,—,e_ WestC kewrojz, <br />) UNKNOWN <br />FELTON. SHARON D. <br />STREET ADDRESS <br />F. <br />DOES THE CONTAINER STORE MOTOR VEHICLE <br />( 03 UNLEADED ( ) 02 REGULAR ( ) 03 <br />FUEL OR WASTE OIL ? "01 YES ( l 02 NO <br />PREMIUM( ) 04 DIESEL ( ) 05 WASTE OIL <br />NEAREST CROSS STREET <br />2905 W. BENJAMIN HOLT <br />" s <br />mom <br />CITY <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/AREA CODE <br />TYPE OF BUSINESS <br />20,9-478-5555 <br />(X) 01 GASOLINE <br />STATION ( ) 02 OTHER <br />NUMBER OF CONTAINERS <br />RURAL AREAS ONLY : <br />TOWNSHIP <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 ( ) CM ( ) UNKNOWN <br />CONTAINER <br />NUMBER tib 2. <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 ( <br />) UNKNOWN <br />JE. DOES THE CONTAINER STORE: ( <br />l 01 WASTE (X) 02 PRODUCT <br />F. <br />DOES THE CONTAINER STORE MOTOR VEHICLE <br />( 03 UNLEADED ( ) 02 REGULAR ( ) 03 <br />FUEL OR WASTE OIL ? "01 YES ( l 02 NO <br />PREMIUM( ) 04 DIESEL ( ) 05 WASTE OIL <br />IF YES CHECK APPROPRIATE BOX(ES): <br />( l 06 OTHER <br />V CONTAINER CONSTRUCTION <br />A. <br />THICKNESS OF PRIMARY CONTAINMENT: 0000250 <br />( ) GAUGE ( ) INCHES ( ) CM ( ) UNKNOWN <br />B. <br />( ) 01 <br />VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON -VAULTED ( ) 03 UNKNOWN <br />C. <br />( ) 01 <br />DOUBLE WALLED (X) 02 SINGLE WALLED ( <br />l 03 LINED <br />D. <br />(.Id 01 <br />( l 12 <br />CARBON STEEL f ) 02 STAINLESS STEEL ( <br />06 ALUMINUM ( l 07 STEEL CLAD ( 108 <br />UNKNOWN ( ) 13 OTHER: <br />) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br />BRONZE ( l 09 COMPOSITE ( J 10 NON-METALLIC <br />HSC04-070185 (10/18/85) PAGE 1 <br />6I <br />