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r <br />• <br />0STATE ID NUMBER 90000062853004 <br />APPLICATION FO,R PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br />t; 01 NEW PERMIT ( l 05 RENEWED PERMIT04 07 TANK D ( ) 09 DELETE FROM FILE (NO FEE) <br />02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT () R CHANGE (NO SURCHARGE) <br />I OWNER <br />NAME(CORPORATION,INDIVIDUAL OR PUBLIC 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 94103 <br />II FACILITY <br />FACILITY'S <br />96+n0.ff 5 <br />r v n 9 / <br />h- <br />�- <br />DEALER/FOREMAN/SUPERVISOR <br />PARKs,B D p I'd Y <br />kTREET ADDRESS <br />MANUFACTURER LIF APPROPRIATE): <br />YEAR MFG: 1964 <br />NEAREST CROSS STREET <br />6633 PACIFIC AVE <br />CONTAINER CAPACITY: 550 GALLONS ( <br />) UNKNOWN <br />BEN HOLT DR <br />CITY <br />DOES THE CONTAINER STORE MOTOR VEHICLE <br />( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 <br />FUEL OR WASTE OIL ? jJrc,01 YES ( ) 02 NO IF YES CHECK APPROPRIATE SOX(ES): <br />PREMIUM ( ) 04 DIESEL j!:C05 WASTE OIL ( ) 06 OTHER <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 />TYPE <br />OF BUSINESS <br />209-477-4115 <br />(X) <br />0`1 GASOLINE STATION ( ) 02 OTHER <br />NUMBER OF CONTAINERS <br />RVRA:L AREAS <br />ONLY <br />TOWNSHIP <br />RANGE <br />SECTION <br />4 <br />III 24 HOUR EMERGENCY CONTACT PERSON <br />NIGHTS: NAME(LAST NAME FIRS7) AND PHONE W/AREA CODE <br />12 <br />DAYS: NAME LAST NAME FIRST) AND PHONE W/AREA CODE <br />MAINTENANCE 425-877-0244 - - <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CO-NTAINER <br />IV DESCRIPTION <br />A. <br />(X) 01 TANK ( l 04 OTHER: <br />) GAUGE t ) INCHES ( ) CM ( ) UNKNOWN <br />CONTAINER NUMBER 4 <br />B. <br />MANUFACTURER LIF APPROPRIATE): <br />YEAR MFG: 1964 <br />C. YEAR INSTALLED 1964 ( ) UNKNOWN <br />0. <br />CONTAINER CAPACITY: 550 GALLONS ( <br />) UNKNOWN <br />JE. DUES THE CONTAINER STORE: (X) 01 WASTE ( ) 02 PRODUCT <br />F. <br />DOES THE CONTAINER STORE MOTOR VEHICLE <br />( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 <br />FUEL OR WASTE OIL ? jJrc,01 YES ( ) 02 NO IF YES CHECK APPROPRIATE SOX(ES): <br />PREMIUM ( ) 04 DIESEL j!:C05 WASTE OIL ( ) 06 OTHER <br />V CONTAINER CONSTRUCTION" <br />A. <br />THICKNESS OF PRIMARY CONTAINMENT: 0000100 ( <br />) GAUGE t ) INCHES ( ) CM ( ) UNKNOWN <br />B. <br />( ) <br />01 <br />VAULTED (LOCATED IN AN UNDERGROUND VAULT) <br />(X) 02 NON -VAULTED ( ) 03 UNKNOWN <br />C. <br />( ) <br />01 <br />DOUBLE WALLED (X) 02 SINGLE WALLED ( ) <br />03 LINED <br />D. <br />(X) <br />( ) <br />01 <br />f ) <br />12 <br />CARBON STEEL i ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( l 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br />06 ALUMINUM ( ) 07 STEEL CLAD t l 08 BRONZE ( l 09 COMPOSITE ( ) 10 NON-METALLIC <br />UNKNOWN ( ) 13 OTHER: <br />HSC94-070185 (10/18/85) <br />PAGE 1 <br />