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• <br /> STATE ID NUMBER 00000062251005 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK. <br /> ( 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED, ( l 09 DELETE FROM FILE ("NO FEE) <br /> C <br /> 1_02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CCRPCRATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CHEVRON U.S.A. INC. ( ) 01 FED ( ) 02 STATE ( 3 03 LOCAL <br /> STREET ADDRESS CITY STATE "ZIP <br /> 575 MARKET SAN FRANCISCO CA 94105 <br /> II FACILITY <br /> FACILITY NAME, DEALER/FOREMAN/SUPERVISOR <br /> 92i96' 's Clavrdr 6EISf,KEITH B <br /> STREET ADOPESS NEAREST CROSS STREET <br /> 25650 HWY 99, NORTH NEAR COLLIER.RD <br /> CITY COUNTY ZIP <br /> ACAMPO SAN JOAQUIN 95220 <br /> MAILING ADDRESS CITY STATE ZIP <br /> //S it/ 111A -e I*emipe- Loot► CA 199eee <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-333-1740 (Xl 01 GASOLINE STATION ( l 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY OW <br /> TNSHIP RANGE SECTION <br /> 6 <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. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 5 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1956 C. YEAR INSTALLED 1956 ( 1 UNKNOWN <br /> D. CONTAINER CAPACITY: 550 GALLONS ( l UNKNOWN JE. DOES THE CONTAINER STORE: (X) 01 WASTE ( ) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? W 01 YES ( l 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( l 03 PREMIUM ( ) 04 DIESEL l 105 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A <br /> A. THICKNESS Of PRIMARY CONTAINMENT: 0000100 ( ) GAUGE ( ) INCHES ( ) CM ( ) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( l 04 POLYVINYL CHLORIDE [ ) 05 CONCRETE <br /> ( ) 06 ALUMINUM [ ) 07 STEEL CLAD ( ) 08 BRONZE ( l 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> i � <br />