Laserfiche WebLink
• • <br />STATE ID NUMBER 00000062853003 <br />APPLICATION FOR PERMIT TO OPERATE UNDERGROU:N.D STORAGE TANK <br />01 NEW PERMIT ( l 05 RENEWED PERMIT (fA 07�� ( 1 09 DELETE FROM FILE (NO FEE) <br />02 CONDITIONAL PERMIT ! ) 06 AMENDED PER ) R CHANGE (NO SURCHARGE) <br />I OWNER <br />N.AME(CORPORATION,INDEVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br />CHEVROH U.S.A. INC. ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br />STREET ADDRESS CITY STATE T94105 <br />575 MARKET SAN FRANCISCO CA <br />II FACILITY <br />FACILITY /NAME <br />THICKNESS OF PRIMARY <br />DEALER/FOREMAN/SUPERVISOR <br />.�� 6i M Par ks <br />kevro <br />PARKS,B D 0 <br />YEAR INSTALLED 1964 ( ) UNKNOWN <br />D. CONTAINER CAPACITY: 7000 GALLONS ( ) UNKNOWN <br />/ <br />STREET ADDRESS <br />) 01 WASTE (X) 02 PRODUCT <br />NEAREST CROSS STREET <br />6633 PACLFIC AVE <br />IF YES.CHECK APPROPRIATE SOX(ES): <br />( ) 06 OTHER <br />BEN HOLT DR <br />CITY <br />D. <br />COUNTY <br />ZIP <br />STOCKTON <br />POLYVINYL CHLORIDE ( ) 05 CONCRETE <br />t J 10 NON-METALLIC <br />SAN JOAQUIN <br />93207 <br />MAILING ADDP.ESS <br />CITY <br />STATE <br />ZIP <br />6633 PACIFIC AVE <br />STOCKTON <br />CA <br />95207 <br />PHONE W/AREA CODE <br />TYPE OF BUSINESS <br />209-.477-4115 <br />(X) 01 GASOLINE STATION ( ) 02 OTHER <br />NUMBER OF CONTAINERS <br />RURAL AREAS ONLY <br />TOWNSHIP <br />RANGE <br />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 FPR EACH CONTAINER <br />IV DESCRIPTION <br />A. (X) 01 TANK ( 3 04 OTHER: <br />THICKNESS OF PRIMARY <br />CONTAINER NUMBER 3 <br />B. MANUFACTURER (IF APPROPRIATE): <br />YEAR MFG: 1964 <br />C. <br />YEAR INSTALLED 1964 ( ) UNKNOWN <br />D. CONTAINER CAPACITY: 7000 GALLONS ( ) UNKNOWN <br />E. DOES THE <br />CONTAINER STORE: f <br />) 01 WASTE (X) 02 PRODUCT <br />F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? <br />(4 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL— <br />01 YES ( ) 02 NO <br />( l 05 WASTE OIL <br />IF YES.CHECK APPROPRIATE SOX(ES): <br />( ) 06 OTHER <br />V CONTAINER CONSTRUCTION <br />A. <br />THICKNESS OF PRIMARY <br />CONTAINMENT: 00.00250 ( <br />l GAUGE ( ) INCHES ( <br />l CM ( ) UNKNOWN <br />B. <br />( ) <br />01 VAULTED (LOCATED IN AN, UNDERGROUND VAULT) <br />(X) 02 NON -VAULTER ( <br />) 03 UwNOWN <br />C. <br />( ) <br />01 DOUBLE WALLED <br />(X) 02 SINGLE WALLED ( ) <br />03LINED <br />D. <br />(X) <br />( <br />( ) <br />01 CARBON STEEL <br />) 06 ALUMINUM <br />12 UNKNOWN ( ) <br />( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS E ) 04 <br />( l 07 STEEL CLAD i ) 08 BRONZE ( J 09 COMPOSITE <br />13 OTHER: <br />POLYVINYL CHLORIDE ( ) 05 CONCRETE <br />t J 10 NON-METALLIC <br />HSC04-070185 (10/18/85) <br />PAGE 1 <br />