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• STATE ID NUMBER 00000062186001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> q(S 01 NEW PERMIT ( 1 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(CORPOPATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CHEVRON U.S.A. INC. ( ) 01 FED ( ) 02 STATE ( 7 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 575 MARKET SAN FRANCISCO CA 94105 <br /> II FACILITY <br /> FACILITY AME DEALER/FOREMAN/SUPERVISOR <br /> 92033 f-j4cft0 MtR1(-.flne - <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 508 W. CHARTER. WAY LINCOLN <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95206 <br /> MAILING ADDRESS .CITY STATE .ZIP <br /> 508 W. CHARTER WAY STOCKTON CA 95206 <br /> PHONE W/AREA CODE TYPEOF BUSINESS <br /> 209-443-4T2fr Vf(o2-119 (X1 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 FIPST) 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 ( 1 04 OTHER: iCONTAINER NUMBER `r*13 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1972 C. YEAR INSTALLED 1972 f 1 UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS ( l UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> (x) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 0000250 ( ) GAUGE ( ) INCHES ( ) CM ( ) UNKNOWN <br /> B. ( 1 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. E>'01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> ( ) 06 ALUMINUM f ) 07 STEEL CLAD ( 1 08 BRONZE ( ) 09 COMPOSITE h ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (.10/18/85) PAGE 1 <br />