COMPLIANCE INFO_2005-2010 - Laserfiche WebLink

Home Browse Search

UIWIED PROGRAM CONSOLIDATED FORW UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-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 below) 430. ❑ 1.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: 430a I DATE EXISTING UST DISCOVERED: 4306. I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) - - 1. BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3. Chevron Station#201383 BUSINESS SITE ADDRESS 103. CITY 104. 1960 W 11th St. Tracy, CA 95376 II. TANK DESCRIPTION TANK ID# 432. TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434. 2 XERXES ® 1.A STAND-ALONE TANK Complete one page for each ❑ 2.ONE IN A COMPARTMENTED UNIT compartment in the unit. DATE UST SYSTEM INSTALLED 435. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS IN THE UNIT 437. 12/17/1992 12,000 0 III. TANK USE AND CONTENTS TANK USE ® la.MOTOR VEHICLE FUELING ❑ lb.MARINA FUELING ❑ lc.AVIATION FUELING 439. ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§25281.5(c)] ❑-6:OTHER GENERATOR FUEL_....._-_.._..............._ ._95:UNKNOWN ❑ 99.OTHER(Specify): 439a. ............ .................__..............................---......_._...__......_.._...._..........--._..... CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED ® 1c.MIDGRADE UNLEADED ❑ Ib.PREMIUM UNLEADED 440. ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS _❑ 8.PETROLEUM BLEND.FUEL....._...._9:._OTHER PETROLEUM..(Specifk')...... 440a. .............................................. NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 440b. IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 95.UNKNOWN 443. __............_...................... --............................................................................................................................._._-...__._.........._------............._............._........................................................................................................................................................................�.._................_. ._._..............._......................................................... PRIMARY CONTAINMENT ❑ 1.STEEL ® 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444. ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 444a. .I.............. - ......_..................__......_.................................................................................._. ................_................................ . SECONDARY CONTAINMENT ❑ 1.STEEL ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445. ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specify):. _.__..._.._.._._...._..__.-......................._........_..._:... --........................................................._....._...---..........................................................--- _,_.................................................... _.-......_..._..�_._. OVERFILL PREVENTION ® 1.AUDIBLE&VISUAL ALARMS [1 2.BALL FLOAT ® 3.FILL TUBE SHUT-OFF VALVE 452. ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ 1.SINGLE WALL ® 2.DOUBLE WALL [199.OTHER 460. . .. _._......._..._..._...._.._.. _..........................................................................................................................................................._-__....._..........._.._......__._....._....._...._._ SYSTEM TYPE ® 1.PRESSURE ❑ 2.GRAVITY ❑ 3:CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR§2636(a)(3)] 458. PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ S.FLEXIBLE ❑ 10.RIGID PLASTIC 464. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464a. _...._._......_...........................................__..._.............._..._._....._-........-..._.._....._................................................................................... - ................ ........................_.......... ....__........_. SECONDARY CONTAINMENT ❑ L STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 46ab. ❑ 90:NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 4640. .............................................................................._...._.-�..........._.-�-_.._... ..-.__....................................._-....................._.....- ---....._- �._.__..__... - __.......................... _..-. PIPING/TURBINE CONTAINMENT SUMP TYPE ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464d. VI. VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ® 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 4664e. 1. .................._..................................--.__...._............--........................-----.................._..-_..._............__.......................................................................................................................................-----............-......... ....................._.-..........._....._..-............... VENT SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): ab flf. ......._._.........................................................................................._._..............._._....---.............................._.__...........................--.....-............._............. . .........................................._..._..................................................._._..._..__..._.._..._.__...r.._.._.._.... _............ 464g. VR PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS [310.RIGID PLASTIC [190.NONE ❑ 99.OTHER(Specify): Mlsi..... ....................................................................................................__............................_. .-_........_........................................-..-_._............................................._...........---........................................_._..._..------..........__..._............................... 464h. VR SECONDARY CONTAINMENT ❑ 1.STEEL El 4.FIBERGLASS [_] 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 464hl. ......................................................................................_......................._..._.-.- .__....................._._._..............._..----._.............._......._...................................................................................................._......................._...._..........................................................._ ...................... VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE 4641. .............._....__.....................................................................-....................-...........................---......--.................-.....,........_..._---..................................................................................................................................._.._.._.............--'---......................................................_........._............._..........................................464'....... RISER PRIMARY CONTAINMENT ® 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): a64ji. -.--......................._................................._._.._......-_.......................---..........._..._......................................................----.. _........................................................................................................................_.-........_....._..-............ 464k. RISER SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 464kl. ................................. ... . . . .. . . .. ---.......... ...................... FILL COMPONENTS INSTALLED ® I.SPILL BUCKET ® 3.STRIKER PLATE/BOTTOM PROTECTOR ® 4.CONTAINMENT SUMP 451a-c. VII. UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE ® 1.SINGLE WALL ❑ 2 DOUBLE WALL ❑ 3 NO DISPENSERS ❑ 90.NONE 46%. ........................................................_.. .. .........................._.. ..._... ............. _................................................. ................ .................._._ .................. .. 469b. CONSTRUCTION MATERIAL ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 469c. VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION 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:rFT�,E(D9WRV'NEZ DATE 01/13/2009 470. APPLICANT NAME(print) Chevron Products Co./FRED MARTINEZ 471. APPLICANT TITLE Chevron Retail HES Permit Desk 472 UPCF UST-B Rev.(12/2007)