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i • <br />STATE ID NUMBER 0.0000062853001 <br />APPLICATION FOR PERMIT TO OPERATE U.NDERGR.OU.ND STORAGE TANK <br />-01 NEW PERMIT ( ) 05 RENEWED PERMIT �-07,TA�LO � ( ) 09 DELETE FROM FILE (NO FEE) <br />"02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br />I OWNER <br />NAME(COR'PORATION,INDIVIDUAL OR PUlSLIC AGENCY) PUBLIC AGENCY ONLY <br />CHEVRON-U.S.A. INC. ( )-01 FED ( ) 02 STATE ( ) 03 LOCAL <br />STREET ADDRESS CITY STATE ZIP <br />575 MARKET SAN FRANCISCO CA 194105 <br />II FACILITY <br />I1I 24 HOUR EMERGENCY CONTACT PERSON <br />DAYS: NAME LAST NAME FIRST) AND PHONEW/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br />MAINTENANCE DISPATCH 415-877-0244 G n: - - <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. (X) 01 TANK ( ) 04 OTHER: lCONTAINER NUMBER cY <br />B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 19641 C. YEAR INSTALLED 1964 ( ) UNKNOWN <br />D. CONTAINER CAPACITY 7000 GALLONS ( ) UNKNOWN JE. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br />F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? jQ"I YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br />I ) 01 UNLEADED jg-:g.02 REGULAR ( J 03 PREMIUM ( l 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br />V CONTAINER CO=NSTRUCTION <br />A. <br />THICKNESS OF PRIMARY <br />CONTAINMENT: 0000250 <br />( ) GAUGE ( ) INCHES ( <br />FACILITY NAME <br />�ar <br />B. <br />( ) <br />DEALER/FOREMAN/SUPERVISOR <br />9� '6; l <br />C. <br />( ) <br />PARKS,B D 0.wY' <br />STREET ADDRESS <br />l 03 LINED <br />NEAREST CROSS STREET <br />6633 PACIFIC AVE <br />01 CARBON STEEL <br />) 06 ALUMINUM <br />12 UNKNOWN ( ) <br />( ) 02 STAINLESS STEEL ( <br />( ) 07 STEEL CLAD ( l 08 <br />13 OTHER: <br />BEN HOLT DR <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 />O1 GASOLINE STATION ( ) 02 OTHER <br />NUMBER OF CONTAINERS <br />RURAL AREAS <br />ONLY <br />TOWNSHIP <br />RANGE <br />SECTION <br />4 <br />I1I 24 HOUR EMERGENCY CONTACT PERSON <br />DAYS: NAME LAST NAME FIRST) AND PHONEW/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br />MAINTENANCE DISPATCH 415-877-0244 G n: - - <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. (X) 01 TANK ( ) 04 OTHER: lCONTAINER NUMBER cY <br />B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 19641 C. YEAR INSTALLED 1964 ( ) UNKNOWN <br />D. CONTAINER CAPACITY 7000 GALLONS ( ) UNKNOWN JE. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br />F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? jQ"I YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br />I ) 01 UNLEADED jg-:g.02 REGULAR ( J 03 PREMIUM ( l 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br />V CONTAINER CO=NSTRUCTION <br />A. <br />THICKNESS OF PRIMARY <br />CONTAINMENT: 0000250 <br />( ) GAUGE ( ) INCHES ( <br />) CM ( .UNKNOWN <br />B. <br />( ) <br />01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NW -VAULTED ( <br />) 03 UNKNOWN <br />C. <br />( ) <br />01 DOUBLE WALLED <br />(X) 02 SINGLE WALLED ( <br />l 03 LINED <br />D. <br />fX) <br />( ) <br />01 CARBON STEEL <br />) 06 ALUMINUM <br />12 UNKNOWN ( ) <br />( ) 02 STAINLESS STEEL ( <br />( ) 07 STEEL CLAD ( l 08 <br />13 OTHER: <br />) 03 FIBERGLASS ( 1 04 <br />BRONZE ( ) 09 COMPOSITE <br />POLYVINYL CHLORIDE ( ) 05 CONCRETE <br />( ) 10 NON-METALLIC <br />HSC04-070185 (10/18/83) <br />0 46 <br />PAGE 1 <br />