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Permit Application <br /> •e..iNrw. <br /> ffot New Permit p oa Installed before July 1, 1984 <br /> C) os Renewed Permit p Amended Permit <br /> ❑oz Provisional Permit p o. Installed atter July 1, 1984 <br /> oe <br /> I Owner <br /> Name ICarooraton In*vduai or Pub6C Agency) <br /> i <br /> Shell oil Corporation <br /> Simet Aoaess coy State <br /> ZIP <br /> 1390 Willow Pass Rd. , #900 Concord I CA I94520 <br /> II Facility <br /> Facrry Name peaty,.. Foremanr SLvenvnson <br /> Shell Station To Be .Announced <br /> Siren Aoaess Nearest Cross Street <br /> Grant Line Rd. /I-205 Toste <br /> c" cov+iy zip <br /> Tracy San Joaquin <br /> Maw,q Awess Caro zip <br /> P•.yte-a,an ea cone Tyne a S. s <br /> of Gasoline Station 0 0 Other <br /> :TU "T <br /> Of CONTA IN C RS Tti.ngMp Range SeQw, <br /> AT TIts ••e 1L I.? Rural Areas <br /> only: <br /> .II 24 Hour Emergency Contact Person ° <br /> pays Name nasi name r.sn anti Prone« area cone mgms Name Basi name i'nsn anti Pnone.. alca coop <br /> Ray Newsome, 415-676-1414 Ext. 128 Ray Newsome <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV Description <br /> cAw.owws how""r Ill ir"C's me n„rror assn On, <br /> A. ❑Xt Tank O oa Other. <br /> B. Manufacturer(if appropriate): Owens Corning Year of Mfg.: 1990 C. Year Installed: 1990 Q Unknown <br /> D. Container Capacity: 12 , 0 Oallons O Unknown E. Does the Container Store (Check One): ❑o+ Waste d oz Product <br /> F. Does the Container Store Motor Vehicle Fuel or Waste Oil? X7 of Yes O oz No It Yes. Check appropriate box(es) <br /> bt Unleaded ❑oz Regular O os Premium �J, o. Diesel ❑os Waste Oil ❑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 IZ Unknown <br /> B. O of Vaulted (Located in an underground Vault.) N oa Non-vaulted O=Unknown <br /> C.IBJ o+ Double Walled O w Single Walled O o3 Lined <br /> D O of Carbon Steel ❑m Stainless Steel EX03 Fiberglass O o. Polyvinyl Chloride O os Concrete O os Aluminum <br /> O or Steel Clad O ce Bronze O o9 Composite O w Non-metallic ❑ it Earthen Walls <br /> 0 tj Unknown 0 13 Other. <br />