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• 0 STATE ID NUMBER 00000062064002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ) O1 NEW PERMIT f 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ). 09 DELETE FROM FILE (NO FEE) <br /> (_r <br /> 2 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPOPATION,INOIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CHEVRON U.S.A. INC. /J( ) 01 FED { ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY 1Qn �Qn7Qvt STATE ZIP /j✓ 03 <br /> �= Z '/nnd 'PA '&&e fcri�e 206 sem— CA <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> 91452 PARKS, BILL JR <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 334. E. MAIN ST. HWY 99 <br /> CIT'f COUNTY ZIP <br /> RIPON SAN JOAQUIN 95366 <br /> MAILING ADDRESS CITY STATE 'ZIP <br /> 334 E. MAIN ST. RIPON CA 95366 <br /> PHONE W/AREA CODE TYPEOF BUSINESS <br /> 209-599-2313 (X) 01 GASOLINE STATION ( 1 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 2 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1969 C. YEAR INSTALLED 1969 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 5000 GALLONS ( ] UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR 1 03 PREMIUM ( ) 04 DIESEL 05 WASTE OIL ( l 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 0000250 f ) GAUGE ( ) INCHES ( ) CM ( ) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X1 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( 7 02 STAINLESS STEEL [ ) 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> (. ) 06 ALUMINUM ( ) 07STEEL CLAD ( 1 08 BRONZE ( 1 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> KSC04-070185 (10/18/85) PAGE 1 <br />