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STATE ID NUMBER 00000062408002 <br />APPLICATION ;FOR ,PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br />(.V-01 NEW PERMIT E } 05 RENEWED PERMIT ( } 07 TANK CLOSED ( 109 DELETE FROM FILE (NO FEE) <br />t J 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT t ) 08 MI 'CHANGE (NO SURCHARGE,) <br />MoffiUM, <br />NAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) 1PUBLIC AGENCY ONLY <br />CHEVRON U.S.A. INC. ( J 01 TED t 102 STATE t ) 03 LOCAL <br />STRaET ADDRESS CITY STATE ZIP <br />575 P1ARKE:1 SAN FRANCISCO CA 94105 <br />II FACILITY <br />WF " <br />FACILITY AME+ <br />93232 f e /s C ke v rein 3eY vl C <br />(X) 01 TANK - ) 04 OTHER: <br />DEALER/FOREMAN/SUPE VISOR <br />t G <br />A .- <br />B. <br />STREET ADDRESS <br />YEAR MFG: <br />C. YEAR INSTALLED t ),UNKNOWN <br />NEAREST CROSS STREET <br />CONTAINER CAPACITY: 100-0 GALLONS A <br />) UNKNOWN <br />8660 LOWER SACRAMENTO RD <br />F. <br />DOES THE CONTAINER STORE MOTOR VEHICLE <br />01 UNLEADED ( ) 02 REGULAR E ) 03 <br />PONCE`DELEON <br />CARBON STEEL <br />t ) 02 STAINLESS STEEL (X 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE t <br />CITY <br />( ) <br />COUNTY <br />( l 07 STEEL CLAD ( ) 08 BRONZE ( 1.09 COMPOSITE ( ) 10 NON-METALLIC <br />ZIP <br />STOCKTON <br />UNKNOWN ( ) <br />13 OTHER: <br />SAN JOAQUIN <br />95207 <br />MAILING ADDRESS <br />CITY <br />STATE <br />ZIP <br />8660 LOWER SACRAMENTO RD <br />STOCKTON <br />CA <br />95207 <br />PHONE W/AREA CODE <br />TYPE <br />OF BUSINESS <br />209-477-0947 <br />(X) <br />01 GASOLINE STATION t ) 02 OT14ER <br />NUMBER OF CONTAIN -ERS <br />RURAL AREAS <br />ONLY <br />TOWNSHIP <br />RANGE <br />SECTION <br />4 <br />III 24 HOUR EMERGENCY CO.,NTACT PERSON <br />DAYS: NAMELLAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AR°EA CODE <br />MAINTENANCE DISPATCH415.877-0244 <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EAC,N CO-NTAINER <br />IV DESCRIPTION <br />A. <br />(X) 01 TANK - ) 04 OTHER: <br />CONTAINMENT: 0000370 ( ) GAUGE ( ) INCHES ( ) CM t I UNKNOWN <br />CONTAINER NUMBER ' <br />B. <br />MANUFACTURER (IF APPROPRIATE): <br />YEAR MFG: <br />C. YEAR INSTALLED t ),UNKNOWN <br />D. <br />CONTAINER CAPACITY: 100-0 GALLONS A <br />) UNKNOWN <br />JE. DOES THE CONTAINER STORE: (X) 01 WASTE - ) 02 PRODUCT <br />F. <br />DOES THE CONTAINER STORE MOTOR VEHICLE <br />01 UNLEADED ( ) 02 REGULAR E ) 03 <br />FUEL OR WASTE OIL ? 010 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br />PREMIUM t ) 04 DIESEL 0<r 05 WASTE OIL ( ) 06 OTHER <br />V CONTAINER CONSTRUCTION <br />A. <br />THICKNESS OF PRIMARY <br />CONTAINMENT: 0000370 ( ) GAUGE ( ) INCHES ( ) CM t I UNKNOWN <br />B. <br />( ) 01 <br />VAULTED (LOCATED IN AN UNDERGROUND VAULT) EX) 02 NON -V LTID ( ) 03 UNKNOWN <br />C. <br />( ) 01 <br />-DOUBLE WALLED <br />(X) 02 SINGLE WALLED ( ) 03 LINED <br />D. <br />( ) 01 <br />CARBON STEEL <br />t ) 02 STAINLESS STEEL (X 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE t <br />1 05 CONCRETE <br />( ) <br />06 ALUMINUM <br />( l 07 STEEL CLAD ( ) 08 BRONZE ( 1.09 COMPOSITE ( ) 10 NON-METALLIC <br />t l 12 <br />UNKNOWN ( ) <br />13 OTHER: <br />HSC04-070185 (1:0118185) <br />PAGE 1 <br />