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3I-yblll UNIFIED PROG CONSOLIDATED FORM UNDERGROUNDSTORAGETANK OPERATING PERMIT AP LICATION-TANK INFORMATION (One form per UST) TYPE OF ACTION (Check one item only. For a UST closure or removal,complete only this section and Sections I,II,III,IV,and IX 6elowJ °3a. ❑ 1.NEW PERMIT ® 3.RENEWAL PEUvIIT 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL 430b,DATE UST PERMANENTLY CLOSED: 438a DATE EXISTING UST DISCOVERED: I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) - - BUSINESS NAME(Same as Facility Name or DBA-Doing Business Chevron Station#210997 BUSINESS SITE ADDRESS 103. CITY loa. 1442 A Colony Drive Ripon, CA 95366 II. TANK DESCRIPTION TANK ID# 432, TANKMANUFACTJURER 433. TANKCONFIGURATION:THISTANKIS 434_ 2 xERxEs N L A STAND-ALONE TANK C.Mim n.p .6age for w ❑ 2.ONE IN A COMPARTMENTED UNIT wmpucmmt in 6e unit DATE UST SYSTEM INSTALLED 435. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS IN THE UNIT 437. 01/16/2003 15,(00 III. TANI,USE AND CONTENTS TANK USE ® Ie.MOTOR VEHICLE FUELING Ib. NA FUELING ❑ IC.AVI UONFUELING tl9_ ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4. OUS WASTE(Includes Used Od) ❑ 5.EMERGENCY GENERATOR FUEL RISC§252815(.)) ❑ 6.OTHER GENERATOR FUEL ❑ 95.Ul KNOWN ❑ 99.OTHER(Specify): 439, CONTENTS PETROLEUM: ❑ 1,REGULAR UNLEADED Ic.MIDGRADE UNLEADED ® It.PREMIUM UNLEADED 440. ❑ 3.DIESEL 5.JET FUEL ❑ 6.AVIATION GAS 440, _❑_ S.PETROLEUM BLEND FUEL 9.OTHER PETROLEUM(Specify): NO N-PETROLEUM ❑ 7.USED OI. 10.ETHANOL ❑ H.OTHERNON-PETROLEUMS Mob' IV. T CONSTRUCTION TYPE OF TANK ❑ L SINGLE WALL N 2.DOUBLE_W_AL_L ❑ 95.UNKNOWN _ 443' PRIMARY CONTAINMENT ❑ 1.STEEL N 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 944' ❑ 7.STEEL+INTERNAL LINING _ 0 95 UNKNOWN ❑ 99 OTHER(SPecify): SECONDARY CONTAINMENT ❑ L STEEL N 3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Speeify): ansa OVERFILL PREVENTION N 1.AUDIBLE&.VISUAL ALARMS N 2.BALL FLOAT ❑ 3.FILL TUBE SHUT-OFF VALVE 652' ❑ 4.TANK MEETS REIQUIREMENTFOR EXEMPTION FROM OVERFILL PREVENTION E UIPMENT V. PRODUCT/W kSTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ 1.SINGLE WALL N 2.DOUBL E WALL ❑ 99.OTHER(Specity): SYSTEM TYPE N 1.PRESSURE ❑ 2.GRA ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR§2636(a)(3)j 458. PRIMARY CONTAINMENT ❑ I.STEEL N 4.FIBER,(LASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464. ❑ 90.NONE ❑ 95.UNK OWN ❑ 99.OTHER(Specify)- a64a SECONDARY CONTAINMENT ❑ 1.STEEL N 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464b. ❑ 90.NONE ❑ 95.UN OWN_ ❑ 99.OTIIBR(Specify): PIPINGfNRBINE CONTAI NMENT SUMP TYPE N I.SINGL WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464d. VI. VENT,VAPOR RECOVERY(VR) kND RISER/FILL PIPE PIPING CONSTRUCTIO N VENT PRIMARY CONTAINMENT ❑ LSTEEL N 4.FIBER ASS ❑ 10.RIGID PLASTIC❑ 90.NONE❑ 99.OTBER(Specify): d dei VENT SECONDARY CONTAINMENT ❑ 1.STEEL❑ 4.FIBERGASS ❑ 10.RIGID PLASTIC N 90.NONE❑ 99.OTHER(Specify): 464 a64n. VR PRIMARY CONTAINMEN T ❑ 1.STEEL® 4.FIBER S ❑ 10.RIGID PLASTIC❑ 90.NONE❑ 99 OTHER(Specify): 4648 a64 1. 464h. VR SECONDARY CONTAH4MENT ❑ 1.STEEL[14.FIBER ASS ❑ 10.RIGID PLASTIC N 90.NONE❑ 99.OTHER(Specify): _464h1. VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE W ALL❑ 2.DOUBLE WALL N 90.NONE RISER PRIMARY CONTAINMENT N 1.STEEL❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC❑ 90.NONE ❑ 99.OTHER(Specify): q j; RISER SECONDARY CONTA IMMENT ❑ 1.STEEL❑ 4.FIBERGLASS ❑ 10.AIGID PLASTIC N 90.NONE ❑ 99.OTHER(Specify): 464k1, FILL COMPONENTS INSTA LLED N 1.SPILL BUCKET N 3.STRIKER PLATFIBOTTOM PROTECTOR N 4.CONTAINMENT SUMP 451 as VII. UNDER DIS ENSER CONTAINMENT(UDC) CONSTRUCTION TYPE N_1.SINGLE WALL O?.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ W.NONE 469, CONSTRUCTION MATERIAL. ❑ 1.STEEL N 4.FIB RGLASS ❑ 10.RIGIDPLASTIC ❑ 99-OTHER(Specify) m9c. VIII. COI ROSION PROTECTION a,,4 STEEL COMPONENT PROTE CTION ❑ 2.SACRIFICIAL AN D 8 ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION -':_; 44t IX. API LICANT SIGNATURE CERTIFICATION: 1 certify that this UST system is compatible with the hazardous substance stored and that the information pr 'ded herein is true, accurate,and in full compliance with II requirements. �' 4]0. APPLICANT SIGNATURE: - DATE 02/11/2011 APPLIC ANT NAME(print) Chevron Products Co./ 411' 1 APPLICANT TITLE Chcvron Retlil HF,S Permit' esk dn. UPCF UST-B Rev.(12/2007)