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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUNDSTORAGETANK OPERATING PERMIT APPLICATION-TANK INFORMATION(One form per UST) TYPE OF ACTION (Check one item only. For an UST permanent closure or removal,complete only this section and Sections I,11,III,N,and IX below) 430 ® L NEW PERMIT ❑ 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 430. I DATE EXISTING UST DISCOVERED: 430b I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) 1 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 Chevron Manteca BUSINESS SITE ADDRESS 103 1490 South Main St . CITY Manteca 104 II.TANK DESCRIPTION TANK ID# 432 TANK MANUFACTURER 433 TANKCONFIGURATION: IIRSTANKIS 434 2 Xerxes L.vvff❑LA STAND-ALONE TANK 1 2.ONE IN A COMPARTMENTED UNIT. Com le¢one page for each com moms in the wit DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 May 2Q1R 8 000 2 III.TANK USE AND CONTENTS TANK USE ® la.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ lc.AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used on) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§25281.5(1)] ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 439a CONTENTS PETROLEUM: ❑ I..REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ® Ib.PREMIUM UNLEADED 49U ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM S eci : 44ea NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 44Ub IV. TANK CONSTRUCTION TYPE OF TANK 01.SINGLE WALL ER2.DOUBLE WALL ❑ 9S.UNKNOWN 443 PRIMARY CONTAINMENT ❑ 1.STEEL 1Z 3.FIBERGLASS ❑ 6.INTERNAL BLADDER ❑ 7.STEEL,INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 444. SECONDARY CONTAINMENT ❑ 1.STEEL ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445 ❑ 90.NONE ❑ 95.UNKNOWN El 99.OTHE (Specify): 445a OVER FILL PREV'EN"PION ❑ I.AUDIBLE&VISUAL ALARMS ❑ 2.BALL FLOAT P9 3.FILL TUBE SHUT-OFF VALVE 452. ❑ 4.TANK MEETS REQUIREMENT S FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ L SINGLE-WALLED Q.2.DOUBLE-WALLED ❑99.OTHER 460 SYSTEM TYPE 99 I.PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR§2636(.)(3)] 458 PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Spmify): 464a SECONDARY CONTAINMENT ❑ L STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ HL RIGID PLASTIC 464b ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Spccify): 4641 PIPING/TURBINE CONTAINMENT SUMP TYPE ❑ 1SINGLE WALL ® 2.DOUBLE WALL Ell 90.NONE 4644 VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ 1.STEEL P3 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464e 464e1 VENT SECONDARY CONTAINMENT ❑ 1.STEEL 0 4.FIBERGLASS ❑ HT RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464f 4Mf3 VR PRIMARY CONTAINMENT ❑ 1.STEEL ER 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 4646 464 VR SECONDARY CONTAINMENT ❑ 1.STEEL R 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464h 464h1 VENT PIPING TRANSITION SUMP TYPE ❑ L SINGLE WALL 91 2.DOUBLE WALL ❑ 90.NONE 464i. RISER PRIMARY CONTAINMENT (R I.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Spceify) 4&IJ 464 I RISER SECONDARY CONTAINbIDJT ❑ L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC [R 90.NONE ❑ 99.OTHER(Specify) 464k 464k] FILL COMPONENTS INSTALLED El L SPILL BUCKET M 3,STRIKER PLATE/BOTTOM PROTECTOR ® 4 CONTAINMENTSUMP 45m.c VII. UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ❑ I.SINGLE WALL ® 2.DOUBLE WALL ❑ 3.CO DISPENSERS ❑ 90.NONE 469a CONSTRUCTION MATERIAL ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10 RIGIDPLASHC ❑ 99.01 HER 469b-c VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION N/A 448. IX. APPLICANT SIGNATURE CERTIFICATION: I certify that this UST system is compatible with the hazardous substance stored and that the information provided herein is true,accurate, and in full compliance with legal requirements. APPLICANT SIGNATURE DATE 470. APPLICANT NAME(print) 671' APPLICANT TITLE 472' UPCF UST-B-1/2 Rev.(12/2007)