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Permit Application <br /> •e.l►ww wry <br /> dot New Permit O oa Installed before July 1, 1984 ®o: Renewed Permit O oe Amended Permit <br /> O os Provisional Permit O o4 Installed after July 1, 1984 <br /> I Owner <br /> Name tCorPorw+on indsrdual or Public Agency) <br /> Shell Oil Corporation <br /> Street Atioress Cay Slate zip <br /> 1390 Willow Pass Rd. , #900 Concord CA 1 94520 <br /> II Fadlfty <br /> Fadry Name De akw,Forenunisuwe stir I <br /> Shell Station To Be .Announced <br /> Street Acoress Newest Cross Site!" <br /> Grant Line Rd. /I-205 Toste <br /> Cay Carry ZIP <br /> Tracy San Joaquin <br /> Maarrq AtiaessCay stale Zip <br /> i <br /> Pnpne w/area code typeW Business <br /> o+ Gasoline Station O oz Other <br /> NUMIILR Of CONTAINERS Township Range secton <br /> AT TNI: ActILTy Rural Areas <br /> Only: <br /> .II 24 Hour Emergency Contact Person <br /> Days Name(last name instl anti Phone w area code Mgrsts Name bast name rash and Pnone w arra CWP <br /> Ray Newsome, 415-676-1414 Ext. 128 Ray Newsome I <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV Description <br /> CgetfRNear PAW j®ar to mere.s no n„mtmr assign one. <br /> A. D& Tank O os Other. 1 <br /> B. Manufacturer(if appropriate): Owens Corning Year of Mfg._ 1990 C. Year installed: 1990 O Unknown <br /> D. Container Capacity: 12 , 0 Oallons O Unknown E. Does the Container Store (Check One): O of Waste b o2 Product <br /> F. Does the Container Store Motor Vehicle Fuel or Waste Oil? Xl of Yes O oz No If Yes. Check appropriate box(es): <br /> 0bl Unleaded O os Regular O oa Premium )qoa Diesel O os Waste Oil O oe Other (List) <br /> If you answered yes; do not complete Part VIII. <br /> V Container Construction <br /> A. Thickness of Primary Containment: O Gauge O Inches O cm Kl Unknown <br /> B. O o+ Vaulted (Located in an underground Vault.) 12 o:Non-vaulted O o3 Unknown <br /> C.11b 0+ Double Walled O w Single Walled 003 Lined <br /> D O of Carbon Steel O w Stainless Steel I'Ko3 Fiberglass O a Polyvinyl Chloride O os Concrete O tib Aluminum <br /> O of Steel Clad O oe Bronze O o9 Composite O to Non-metallic O is Earthen Walls <br /> 0 12 Unknown O 13 Other <br />