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STATE ID NUMBER 000000619S3001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 91 NEW PERtIlL 05 RENEWED PERMIT [ 1 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 0202 CITIONX <br /> L PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I <br /> OWNER <br /> NAME(CO PPORATION,INDIVIDUAL OR PUSLIC AGENCY) PUBLIC AGENCY ONLY <br /> CHEVRON U.S.A. INC. ( 1 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS l Ju [„ CITY fah a'ro%j STATE ZIP z (ix <br /> 7 <br /> 02 n ��/'(��P SAN FRANCISCO CA 9410E <br /> II FACILITY <br /> FACILITY NAME // C1 /� DEALER/FOREMAN/SUPERVISOR <br /> 90959 /y`�J7� C.�PI�YOI� MESERVY, JAMES <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 103 WEST 11TH. ST. ADAM ST <br /> CITY COUNTY ZIP <br /> TRACY SAN JOAQUIN 95376 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 103 WEST 11TH ST. TRACY CA 95376 <br /> P NONE W/ARCA CODE TYPE OF EUSINESS <br /> 209-835-7900 (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 NIONTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> (MAINTENANCE DISPATCH 415-877-0244 <br /> COMPLETE TH.E FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( 1 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1977 C. YEAR INSTALLED 1977 [ 1 UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? yc) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> N 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 f ) INCHES ( I CM f 1 UNKNOWN <br /> S. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (XI 02 NON-VAULTED 1 1 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( 103 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( 1 08 BRONZE f ) 09 COMPOSITE f ) 10 NEW(-METALLIC <br /> ( l 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070105 f10/18/851 PAGE 1 <br />