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STATE ID NUMBER 00000063247003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STOR:AG.E TANK <br /> (K) 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( J 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> E J 02 CONDITIONAL PERMIT E J 06 AMENDED PERMIT t ) 08 MINOR CHANGE (M SURCHARGE) <br /> I O W N.E R' <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CHEVRON U.S.A. INC. ( ) 01 FED ( ) 02 STATE t ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 575 MARKET SAN FRANCISCO CA 94105 <br /> II FACILITY <br /> FACILITY N ME DEALER/FOREMAN/SUPERVISOR <br /> 99840 ndv S CKevron 4%G. HATFIELO,ANDY <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 4400 WATERLOO RD HWY 99 <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95205 <br /> MAILING ADDRESS CITY 7CA <br /> ATE ZIP <br /> 4400 WATERLOO RD STOCKTON 1 95205 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 203-931-2286 (X) 03 GASOLINE STATION ( J 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' AINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. ,YEAR INSTALLED ` E ) N <br /> D. CONTAINER CAPACITY: 10000 GALLONS ( ) UNKNOWN JE. DOES THE CONTAINER STORE: f ) 01 WASTE (X) 02 ;PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL 09 WASTE OIL ? PQ 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> 06 01 UNLEADED t ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL t ) 05 WASTE OIL t ) 06 OTHER <br /> V CONTAINER CONSTRUCTION' <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 0000250 t ) GAUGE t ] INCHES ( ) CM t ) UNKNOWN <br /> B. t ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (;X) 02 NON-VAULTED ( ) 03'UNKNOWN <br /> C. (>rl 01 DOUBLE WALLED 4'"-02 SINGLE WALLED E ) 03 LINED <br /> 0. .f3CJ�01 CARBON STEEL ( ) 02 STAINLESS 'STEEL (,�(f 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( 06"ALUMINUM t ) 07 STEEL CLAD ( ) 08 BRONZE ( ):09 COMPOSITE t ) 10 METALLIC <br /> t ) 12 UNKNOWN t 7 13 OTHER:' <br /> NSC04-070185 (20/18/85) PAGE I <br />