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• • <br />STATE It NUMBER 00000062853002 <br />APPLICATION FOR PERMIT TO OPERATE UNDER,GRE-UND STORAGE TANK <br />t ) 01 NEW PERMIT ( ) 05 RENEWED PERMIT( 07 TAW CLOSED t ) 109 DELETE FROM FILE (NO FEE) <br />1 02 CONDITIONAL PERMIT ( ) 06 AMENDED PER '( ) 08'RIM"MUE (NO SURCHARGE) <br />I OWNER <br />NAME(COP.PORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br />CHEVRON U.S.A. INC. f ) 01 FED { ) 02 STATE ( # 03 LOCAL <br />STREET ADDRESS CITY STATE ZIP <br />575 MARKET SAN FRANCISCO CA 94105 <br />II FACILITY <br />FACILITY NAME �°Vr^oYj <br />'361-7+ 8 i �' Qr 5 <br />% I �I— <br />o h. <br />( ) GAUGE ( ) INCHES ( <br />DEALER/FOREMAN/SUPERVISOR <br />PARKS rB D j em �or <br />STREET ADDRESS <br />I )-01,VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON -VAULTED ( <br />) 03 UNKNOWN <br />NEAREST CROSS <br />STREET <br />6633 PACIFIC AVE <br />D. <br />BEN HOLT OR <br />) 03 FIBERGLASS ( 1 04 <br />'BRONZE ( ) 09 COMPOSITE <br />CITY <br />COUNTY <br />ZIP <br />STOCKTON <br />SAN JOAQUIN <br />95207 <br />MAILING ADDRESS <br />CITY <br />STATE <br />ZIP <br />6633 PACIFIC AVE <br />STOCKTON <br />CA <br />95207 <br />PHONE W/AREA CODE <br />TYPEOF <br />BUSINESS <br />209-477-4115 <br />(X) <br />01 GASOLINE STATION ( l 02 OTHER <br />NUMBER OF CONTAINERS <br />URAL AREAS <br />TP <br />ONLY JTOWNSHIP <br />RANGE <br />SEC TION <br />4. <br />III 24 HOUR EMERGENCY CONTACT PERSON <br />DAYS: NAME LAST NAME FIRST) AND PHONE W/AREA CODENIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br />MAINTENANCE DISPATCH 415-877-0244 50.m <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER -e <br />B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1964 C. YEAR INSTALLED 1964 ( ) UNKNOWN <br />D. CONTAINER CAPACITY: 4000 GALLONS ( ) UNKNOWN JE. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br />F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE O.IL ?JW. 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOXIES)= <br />t l 01 UNLEADED ( ) 02 REGULAR (kl 03PREMIUM ( 04 DIESEL f ) 05 WASTE OIL ( ) 06 OTHER <br />JA L <br />V CONTAINER CONSTRUCTION <br />A. <br />THICKNESS OF PRIMARY CONTAINMENT: 0000170 <br />( ) GAUGE ( ) INCHES ( <br />) CM .4gLUNKNOWN <br />B. <br />I )-01,VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON -VAULTED ( <br />) 03 UNKNOWN <br />C. <br />( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED E <br />) 03 LINED <br />D. <br />(X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( <br />( 1.06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 <br />( ) 12 UNKNOWN :( l 13 OTHER: <br />) 03 FIBERGLASS ( 1 04 <br />'BRONZE ( ) 09 COMPOSITE <br />POLYVINYL CHLORIDE ( ) 05 CONCRETE <br />( ) 10 NON-METALLIC <br />HSC04-070185 (10/18/85) <br />PAGE 1 <br />