Laserfiche WebLink
STATE ID NUMBER 00000061703001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> L,,V,01 NEW PERMIT t ) 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(COP.POPATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CHEVRON U.S.A. INC. ( ) 01 FED f ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE IIP <br /> 575 MARKET SAN FRANCISCO CA 94105 <br /> II FACILITY <br /> FACILITYNAM DEALER/FOREMAN/SUPERVISOR <br /> p C ov( Q- C 2Vr KUBACH, KENT W , o,i r <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 101 N. CHEROKEE LANE ELM <br /> CITY COUNTY ZIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESS CITY STATE 2IP <br /> 101 N. CHEROKEE LANE LODI CA 95240 <br /> PHONE W/AREA CGDE TYPEOF BUSINESS <br /> 209-334-9361 (X) 01 GASOLINE STATION ( ) 02 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 - - <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: 1966 C. YEAR INSTALLED 1966 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 7500 GALLONS f 1 UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? Qd.01 YES ( ) 02 NO IF YES CHECK APPROPRIATE SOX(ES): <br /> X01 UNLEADED l4 02 REGULAR ( 1 03 PREMIUM ( ) 04 DI ( I OS WASTE OIL ( 106 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 0000250 ( ) GAUGE ( I INCHES ( ) CM t 7 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 f l 03 LINED <br /> 0. (X) 01 CARBON STEEL f ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE f 7 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 1 07 STEEL CLAD f ) 08 BRONZE f ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> 1 ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />