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BILLING_PRE 2019
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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2300 - Underground Storage Tank Program
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PR0541416
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BILLING_PRE 2019
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Entry Properties
Last modified
1/18/2019 2:56:43 PM
Creation date
9/19/2018 8:39:33 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
BILLING
FileName_PostFix
PRE 2019
RECORD_ID
PR0541416
PE
2351
FACILITY_ID
FA0023733
FACILITY_NAME
Sunwest Chevron
STREET_NUMBER
2758
Direction
W
STREET_NAME
KETTLEMAN
STREET_TYPE
Ln
City
Lodi
Zip
95242
APN
16646031
CURRENT_STATUS
01
SITE_LOCATION
2758 W Kettleman Ln
QC Status
Approved
Scanner
KBlackwell
Tags
EHD - Public
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UNIFIED PROGRAM CONSOLIDATED FORM` S <br />UNDERGROUND STORAGE TANKDr 0VeEE <br />OPERATING PERMIT APPLICATION - TANK INFORMA <br />TYPE OF ACTION (Check one item only. For,n UST permanent closure or removal, complete only this Section and Sections I, B, III, IR V- -I IX below C 430 <br />1. NEW PERMIT : 3. <br />RENEWAL PERMIT ❑ S. CHANGE OF INFO mPIIItYN u <br />❑ 6. TEMPORARY UST CLOSURE LJ 7. UST PERMANENT CLOSURE ON SITE ❑ 8. UST REMOVAL <br />DATE UST PERMANENTLY CLOSED: °30i I DATE EXISTING UST DISCOVERED: 430b <br />I. FACILITY INFORMATION ENVIRONMENTAL HEALTF <br />FACILITY ID # (Agency Use only) <br />- <br />- <br />D P <br />RT <br />E T <br />t <br />BUSINESS NAME (Same as FACILITY NAME or DBA-DIing Business As) <br />UN Vr45lbi 2356 T k 05 )-0'g 11 len y� <br />BUSINESS SITE AD r tR�103 <br />N��rt� �.Ara� <br />CITY io4 <br />tGpt 1.,3 tl l��rll� <br />H. TANK DESCRIPTION <br />TANK ID # 432 <br />TANK MANUFACTURER 433 <br />TANK CONFIGURATION: TFIIS TANK IS 434 <br />I� �j J <br />*2, <br />C6NS'Pt lim M tAT- <br />s©L\J 1101-a <br />1. A STAND-ALONE TANK <br />� 2. ONE M A COMPARTMENTED t1NT. <br />Com kte one pap for earbw tin me wdt. <br />DATE UST SYS INSTALLED 435 <br />TANK jY IN GALLONS 436 <br />NUMBER OF COMPARTMENTS IN THE UNIT 437 <br />l.9pqCI <br />M. TANK USE AND CONTENTS <br />TANK USE N la MOTOR VEHICLE FUELING ❑ Ib. MARINA FUELING ❑ Ic. AVIATION FUELING 439 <br />❑ 3. CHEMICAL PRODUCT STORAGE ❑ 4. HAZARDOUS WASTE(I.duda Used Oil ❑ 5. EMERGENCY GENERATOR FUEL IHSC¢25291.5(c)I <br />❑ 6.OTHER GENERATOR FUEL ❑ 95. UNKNOWN ❑ 99. OTHER (Specify): 439a <br />CONTENTS PETROLEUM: ❑ la REGULAR UNLEADED ❑ Ic. MIDGRADE UNLEADED 10 lb. PREMIUM UNLEADED 440 <br />❑ 3. DIESEL ❑ 5. JET FUEL ❑ 6. AVIATION GAS <br />❑ S. PETROLEUM BLEND FUEL ❑ 9. OTHER PETROLEUM (S ): "0. <br />NON -PETROLEUM: ❑ 7. USED OIL ❑ 10. ETHANOL <br />❑ 11. OTHER NON -PETROLEUM (Specify): 46ob <br />IV. TANK CONSTRUCTION <br />TYPE OF TANK El 1. SINGLE WALL 02. DOUBLE WALL 095. UNKNOWN 443 <br />PRIMARY CONTAINMENT ❑ 1. STEEL 0 3. FIBERGLASS ❑ 6. INTERNAL BLADDER ab4 <br />❑ 7. STEEL + INTERNAL LINING ❑ 95. UNKNOWN ❑ 99.OTHER (Spaify): 444a <br />SECONDARY CONTAINMENT ❑ 1. STEEL 0 3. FIBERGLASS ❑ 6. EXTERIOR MEMBRANE LINER ❑ 7. JACKETED M5 <br />❑ 90. NONE ❑ 95. UNKNOWN ❑ 99.OTHER 5 i ): a5a <br />OVERFILL PREVENTION 0 1. AUDIBLE & VISUAL ALARMS ❑ 2. BALL FLOAT 0 3. FILL TUBE SHUT-OFF VALVE 452. <br />❑ 4. TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT <br />V. PRODUCT/ WASTE PIPING CONSTRUCTION <br />PIPING CONSTRUCTION ❑1. SINGLE -WALLED 02. DOUBLE -WALLED ❑99.OTHER "a <br />SYSTEM TYPE 0 1. PRESSURE ❑ 2. GRAVITY ❑ 3. CONVENTIONAL SUCTION ❑ 4. SAFE SUCTION W CCR 52636(a)(3)] 459 <br />PRIMARY CONTAINMENT ❑ L STEEL ■ 4. FIBERGLASS ❑ S. FLEXIBLE ❑ 10. RIGID PLASTIC 464 <br />❑ 90. NONE ❑ 95. UNKNOWN ❑ 99.OTHER(Specify): 466a <br />SECONDARY CONTAINMENT ❑ 1. STEEL 0 4. FIBERGLASS ❑ 8. FLEXIBLE ❑ 10. RIGID PLASTIC a6w <br />❑ 90. NONE ❑ 95. UNKNOWN ❑ 99. OTHER (Specify): 464c <br />PIPING/TURBINE CONTAINMENT SUMP TYPE ❑ I. SINGLE WALL 0 2. DOUBLE WALL ❑ 90. NONE 464d <br />VI. VENT, VAPOR RECOVERY (VR) AND RISER / FILL PIPE PIPING CONSTRUCTION <br />VENT PRIMARY CONTAINMENT ❑ 1. STEEL 0 4. FIBERGLASS 0 10. RIGID PLASTIC ❑ 90. NONE ❑ 99. OTHER (Specify) 464e <br />464 1 <br />VENT SECONDARY CONTAINMENT 0 1. STEEL 0 4. FIBERGLASS 10. RIGID PLASTIC ❑ 90. NONE ❑ 99.OTHER (Specify) a64f <br />466n <br />VR PRIMARY CONTAINMENT 1. STEEL i 4. FIBERGLASS 0 10. RIGID PLASTIC 0 90. NONE 99. OTHER (Specify) 664g <br />664 1 <br />VR SECONDARY CONTAINMENT ❑ I. STEEL ❑ 4. FIBERGLASS ❑ 10. RIGID PLASTIC 090. NONE ❑ 99. OTHER (Specify) 466h <br />46an1 <br />VEIN PIPING TRANSITION SUMP TYPE ❑ L SINGLE WALL 0 2. DOUBLE WALL Q 90. NONE 464i. <br />RISER PRIMARY CONTAINMENT 1. STEEL 0 4. FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 90. NONE ❑ 99. OTHER (Specify) a64j <br />466' 1 <br />RISER SECONDARY CONTAOQMEM❑ I. STEEL ❑ 4. FIBERGLASS ❑ 10. RIGID PLASTIC 10 90. NONE 099. OTHER (Specify) 4664 <br />464k1 <br />FILL COMPONENTS INSTALLED 0 L SPILL BUCKET ❑ 3. STRIKER PLATE/BOTTOM PROTECTOR N 4. CONTAINMENT SUMP 451a, <br />VII. UNDER DISPENSER CONTAINMENT (UDC) <br />CONSTRUCTION TYPE ❑ I. SINGLE WALL 0 2, DOUBLE WALL ❑ 3. NO DISPENSERS ❑ 90. NONE 469. <br />CONSTRUCTION MATERIAL ❑ 1. STEEL 0 4. FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 99. OTHER (Specify) 46%, <br />VIII. CORROSION PROTECTION <br />STEEL COMPONENT PROTECTION I ❑ 2. SACRIFICIAL ANODES) ❑ 4. IMPRESSED CURRENT 0 6. ISOLATION a48. <br />IX. APPLICANT SIGNATURE <br />CERTIFICATION: I certify that this T system is compatible with the ha2ardoas substance stored and that the information provided herein is true, accurate, <br />and in full com lia with !!gal requirements. <br />APPLICANT SIGNATURE <br />DATE 420 <br />APPLICANT NAME (print 021 <br />APPLICANT TITLE (� r N 4n. <br />UPCF UST -B -1/2 Rev. (12/2007) <br />
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