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Adhk Alk . OWIED PROGRAM CONSOLIDATED FOAWt10 �1 1B�° UNDERGROUND STORAGE TANK l� 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: 430.. 1 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 Station#201761 BUSINESS SITE ADDRESS 103. CITY 104. 1103 S. Main St. Manteca, CA 95337 II. TANK DESCRIPTION TANK ID#t>¢��25'S7B� 432. TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434. 3 XERXES Z I.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. 11/30/1992 12,000 0 III. TANK USE AND CONTENTS TANK USE Z Ia.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)I .........._❑..._6..-OTHER GENERATOR FUEL._._......................................... ----.._.........._........_0..._99:..OTHER(Specify) ... ........ CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED ❑ lc.MIDGRADE UNLEADED ® lb.PREMIUM UNLEADED 440. ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS _................ . .............._.......... .- ..._0..._8..PETROLEUM BLEND FUEL............_ ._9:._OTHER PETROLEUM_(Specify).:...... 440a. ... ..... .............................................. NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 440b. IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL Z 2.DOUBLE WALL ❑ 95.UNKNOWN 443. ................................................._............................................................................__................._...-..........................................................................................._..---.........................._................................................................................................................................................_. PRIMARY CONTAINMENT ❑ 1.STEEL Z 3.FIBERGLASS ❑ 6.INTERNAL BLADDER . 444. _ ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN El 99.OTHER(Specify): 444a. _ ............... ---....................................................................................................__.................._-.-..__.._..................._.__._.........._..........._......................................................_........_...._................................................. ................................................... SECONDARY CONTAINMENT ❑ 1.STEEL Z 3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445. ❑ 90.NONE ❑ 95.UNKNOWN El 99.OTHER(Specify): 445a. _......................_....- ..............._ ....._................_.._.............__..............................._....._......--......................... ...........__................._.._.-... OVERFILL PREVENTION Z 1.AUDIBLE&VISUAL ALARMS ❑ 2.BALL FLOAT Z 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 Z 2.DOUBLE WALL ❑ 99.OTHER 460. ........ ........................................_._....................... _.__._...----.....--....................................__...__....._.............__...._....................-_.-....._..............................................__........................................................................._-.........---.....................................................................................458...... SYSTEM TYPE b..._1.L_PRESSURE 0 2:GRAVITY - 0 3.CONVENTIONAL SUCTION ❑ 4:SAFE SUCTION[23 CCR§263t(a)(3)1._.._................:........:...... - -._. ..............---....- -.. PRIMARY CONTAINMENT ❑ 1.STEEL Z 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464. _ _ ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464a._..................................... ........................................................................................._ SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464b. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c. _...._._...._......._.._............._,..._.._...........-_..................................................................................................................................._ .............................................. PIPING/TURBINE CONTAINMENT SUMP TYPE Z 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464d. VI. VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION 464e. VENT PRIMARY CONTAINMENT ® 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 464e1 ...... ........................................................................................................................................... _._4.............. VENT SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC Z 90.NONE ❑ 99.OTHER(Specify): 46448. ....................................._......................_...._... _.................---._.................................................................................................................................................................._......_.....__...................---.__..................... ....464......... VR PRIMARY CONTAINMENT ❑ 1.STEEL Z 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): i64Rj. ._...._........--- ..__..-__........._..._..............---.._.....................................................................................................................---...._..........................._._.........................---._...._._......_..............................._..._...._._........................................................................................................... VR SECONDARY CONTAINMENT [31.STEEL ❑ 4.FIBERGLASS [110.RIGID PLASTIC Z 90.NONE [199.OTHER(Specify): 464hl ............................................................................................................................................................._.........._.......-----._...._..._....._.............._................................................................................................................................_...._.__._...................----..__.._.........................._........................................ VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL Z 90.NONE 464i. ....................................._...........................---................_.__................_................................................................................................._.._..._.._.-__........---..................................................................................................................................._..__...............__......_.._ RISER PRIMARY CONTAINMENT Z 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90:NONE ❑ 99.OTHER(Specify). 4§4jL_..., .... .... .........................................._......................................._....-.-..._.........-�_-..__..................._.._.__........................................-._......_..._........ _............................ .... ........................ . . 464L RISER SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS [110.RIGID PLASTIC Z 90.NONE El 99.OTHER(Specify): a6ak1. ..........................._..---..-.........................-_...... .........._.._._......................................................................................................................................_...-.................---......_............................................................................................................................................................................................ FILL COMPONENTS INSTALLED Z 1.SPILL BUCKET Z 3.STRIKER PLATEIBOTTOM PROTECTOR Z 4.CONTAINMENT SUMP 45la-c. VII. UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ®..._I.:._SINGLE WALL [1 2.DOUBLE WALL [. 3.NO DISPENSERS 0 90.:NONE 469a. .........................................................................................................._............................... ............................................................._.. ........._ ............. . CONSTRUCTION MATERIAL ❑ 1.STEEL Z 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:VoWAtIj7AEZ DATE 01/13/2009 470 APPLICANT NAME(print) Chevron Products Co./FRED MARTINEZ 471. APPLICANT TITLE Retail HES Permit Desk 472 UPCF UST-B Rev.(12/2007)