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0 0 <br /> STATE ID NUMBER 00000062064004 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 01 NEW PERMIT. ( 7 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CHEVRON U.S.A. INC. [PUBLIC <br /> 01 FED f ) 02.STATE ( ) 03 LOCAL <br /> STREET ADDRESS //�� / CITY 5dA <br /> ��G Mao�ecr_ /7npirhe/,Cq)Yj^� ' �LCI ,a�ZI /lQmon CA <br /> zIP �/57r3 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> 91452 PARKS, BILL JR <br /> STPEET ADDRESS NEAREST CROSS STREET <br /> 334 E. MAIN ST. HWY 99 <br /> CITY COUNTY ZIP <br /> RIPON SAN JOAQUIN 95366 <br /> MAILING ADDRESSCITY STATE ZIP <br /> 334 E. MAIN ST. RIPON CA 95366 <br /> PHONE W/AREA CODE TYPEOF BUSINESS <br /> 3 <br /> 209-599-231 (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/ARCA 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 4 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1969. C. YEAR INSTALLED 1969 ( l UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 GALLONS ( 1 UNKNOWN E. DOES THE CONTAINER STORE: (X) 01 WASTE ( ) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? 1 YES ( ) 02 NQ IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL O P OS WASTE_OIL ( l 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 0000130 ( ) GAUGE ( ) INCHES ( ) CM f 1 UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON—VAULTED ( ) 03 UNKNOWN <br /> C. ( 7 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL f l 02 STAINLESS STEEL ( ) 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( 106 ALUMINUM ( ) 07 STEEL CLAD ( ) OB BRONZE ( ) 09 COMPOSITE ( ) 10 NON—METALLIC <br /> ( ) 12 UNKNOWN ( ] 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />