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UNIFIED PROGRAM CONSOLIDATED FORM �
<br /> E. UNDERGROUND STORAGE TANK
<br /> OPERATING PERMIT'APPLICATION-TANK INFORMATIO a rum per us f)
<br /> 1-Y PH Or AC-1-IO N (Check o»a Item only, For a UST closure or removal,compkm only this section and Sections 1.11.171:IV,and M below) 430•
<br /> ❑ 1,NEW PERMIT ® 3.RENEWAL mmu ❑ 5.CHAN(ils OF INFORMATION
<br /> Ij 6.TEMPORARY UST CLOS1fRE Q 7.t1S'C P1RMANi*NT CLOSURF.ON SITE ❑ $,UST REMOVAL
<br /> DATE UST PERMANENTLY CLOSED: 430i 1 DA'rF EXISTING UST DISCOVERED: 4301,.
<br /> ". :•.. : . ,:'•.: :. :' . I .:.FACILITY`INF.OR'MATIQN:::': .`� �: ....: ::... :... . . '. . ... .'�,'
<br /> FACILITY ID#(Agency f1m Only) I.
<br /> BUSINESS NAME(Nam asFacilayName.orDBA Doing BusiamsAar)
<br /> Chevron Station#201761.
<br /> BUSINESS SITE ADDRESS 1037Z "" 104:
<br /> 1103 S Main St Manteca,CA 95337
<br /> II :TANK DESC
<br /> . RIPTION<
<br /> TANK IU# 432. TAMC MANUFA(TI.IRI ...
<br /> O 433. TANK CONFIGURATION:TI IIS TANK 1S 434.
<br /> IRXE ® 1.A STAND-ALONE TANK Caopluc uw pm fur uch
<br /> ❑ 2.ONE IN A COMPARTMENTED UNIT cmapwrlm m is the wit
<br /> DATE UST SYSTEM INSTALLED 435TANK CAPACITY IN GALLONS 436• NUMHFR OF COMPARTMENTS IN THE UNIT 437
<br /> 11/30/1992 I2,000 .
<br /> .:: '�.:. ... .�:.: '•..:;:::::.'.. � . ' ;:''.III':;;T ,. .:K'•U E;�iND'.:CONT'ENTS�':::'.;:::..
<br /> TANKUSE ® Ia.
<br /> MOTOR CLfi LTNC Ih.MARINA jRLNG lo.AVIATION FUELING 43?.
<br /> ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HA7.ARDOUS W ASTF:(jncltidu Uta/oil) ❑ 5.EMERGENCY GENERATOR FUEL[FISC§25291.5(0)]
<br /> _.........................__...-.....E) 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.0'flimt L$p!xi439x.
<br /> CONTENTS PETROLEUM: ® Ia.REGULAR UNLEADED ❑ Ia.MIIDGRADE UNLEADED ❑ 1 b.PRRMfUM UN[.FAf3$0
<br /> ❑ 3.DIESEL ❑ 5.MT FUEL ❑ 6.AVIATION GAS
<br /> ❑ 8;PETROLEUM BLEND FUEL--❑ 9: �
<br /> -OTHER PETROLEUM(Specify): 4
<br /> NON.alTROr.rUI4f;b i,U$t:t3UIL t] i0,ETHANOL
<br /> I L OTHER NON-PETROLEUMS ): 440b•
<br /> : . .... IV::.T'ANI 'C.ONSTRUCTION
<br /> TYPE OF TANK ❑ 1.SINGLE WALL H 2.DOUBLE WALL [I 95.UNKNOWN 441
<br /> PRIMARY CONTAINMENT ❑ 1.STEEL ® 3.FIBERGLASS ❑ 6.INrERNAL'SLADAE•R 404
<br /> ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN Q 49:OTHER 444x.
<br /> SECONDARY CONTA]NN ❑ 1.STEEL ® 3.FIBERGLASS ❑ 6.EXTERIOR WEMHRANIj[,[NIR ❑ 7.JACKETED 445
<br /> ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 445L
<br /> _.__.UI)II••------FtMS 3 ,RALI •.•_...........-_......_..
<br /> VE'N'1TON ❑ 1,AUDIt94[y�YI$UAI,ALARMS ❑ 2,HALF,I�I,QAT ® 3.PILL TUBE SHUT-OFF VALVE 4S2
<br /> 13 4.TANK MEETS REOUIREVENTS FOR EXEMPTION FROM OVERFILL PREVENTION H UIPMF:NT
<br /> ..: ...
<br /> OWNSTRUCTION.
<br /> PIPING CONSTRUCTION ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 99.07HSR(Specify): adA
<br /> SYSTEM TYPE N 1.PRESSURE 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑_ 4,SAF'F SUCTION,L2.1g.m2wimn 4511
<br /> PRIMARY CONTAINMENT ❑ 1.STEEL N 4.FIBERGLASS ❑ S.FLEXIBLE ❑ 10.R1GI17 PLASTIC: 464.
<br /> ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 4640
<br /> SECON'15ARY
<br /> 6ON-1`AINMF:NT ❑ I.STria, ® 4,PIRFRGtA$.4 ❑ S.r•[.Rx(13LE ❑ 10.RIGID PLASTIC
<br /> ❑ 90.NOW ❑ 95,UNKNOWN ❑ 99.OT1117R(Specify): 4a4c.
<br /> PIPINGfTTIjRBjNE CONTAI NMENT SUMP TYPE 11 I.SINGLE WALL 2.DOUBLE WALL -� ❑ 90.NONE 464d.
<br /> VI ::YEN'T ::VAP.OR:RECQVERY:'(VR).AND RISER?/';FIVE`P 'E:: L ll .G..:.!C TRUCTIO;N':: ' :,.
<br /> VENTPRIMARY(,ON'I'AINMENT [] LSTEEL ® 4,rv3ERGI,AS$ ❑ 1 o,R1Gt)PLASTIC❑ 90.NONE El99.OTHER(Specify): abaci
<br /> VENT SECONDARY CON-rAINMFN'1' ❑ 1,$rFFI,❑ 4,F]HIMCI.ASS ❑ 10.RIGID PI,ASTIC® 90.NONE[399.OTHER(Specify): 460
<br /> VR PRIMARY CONTAiNMEN T ❑.....I.STS...........:..:.....:......................................ai..................-_-
<br /> ........................
<br /> EL 4.F1HEkCrLASS ❑ 18_R1GtU)'LA$'1'lt:[] 90,NONE❑ 99.OTHER(Specify): 464mi
<br /> b.
<br /> ONTAINMENT ❑ I.STEEL❑ 4.FME GLASS ❑ 10.RIGID PLASTIC 90.NONE 99.OTHER(Specify): --4641.
<br /> VR SECONDARY.� C:®' Ll........................._......................................_...__.....____. �__._... _....:...,.....,..,..:......._....------
<br /> VENT PIPING TRANSIT]ON SUMP TYPE p 1.._SINGLE_WALL❑ 2.DOUBLfi Wall ® 90,NONE
<br /> ®.....:..:..... ASS ❑ 10.RIGID P 64R.
<br /> -PLASTIC❑ 90,NONE❑ 99.OTHER(Specify): 464't.
<br /> KISl;R PRIMARY CONTAINMENT 1,R'fhFl❑.4.r'I13F:RGI ...._.._........ . . . ........_-.•_--
<br /> RISER..SECONDARY CON1`A 1NM6N f ❑ L S'I•FBI,❑ 4.BIBERG..ASS ❑ 10.RIGID 1'I.ASTIC® 90.NONE El 99. (Specify): a6�4I 1
<br /> FILL COMPONENTS iNSTA I,1,H13 3.%"rRIKF.R PIA'i'F'1130'1-"OMPROTEC.'TOR N 4.CONTAINMENT SUMP Osla-c-
<br /> vlIi?:UNDER DIS .E1rISER:.CONT
<br /> AIlVME.
<br /> ... :..........:..:... .... ...
<br /> CONSTRU(`I'ION TYPE ® ).51NG1X WALL d 2,muss WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469x.
<br /> ........::.....
<br /> CUNSTRU(;r1ON MATERIAL ❑ I.STEEL ® 4.FIAERGI,ASS ❑ 10.RIGID PLASTIC ❑ 99.0THER(Specify} 469<:
<br /> 777" VTll::~.CdR45YUN:PI�O.TECTION
<br /> STEEL COMPONENT PROTE MON 2.SACRIFICIAL ANDD S) 4.IMPREC-990 CURRENT ® 6,ISOLATION
<br /> .GNAT.IIRE
<br /> CER'11FICXFJON: t certify that this USI'system is compatible with the hazardous substance stored and that the information provid0d Ltre]a is true,
<br /> accurate,and in full compliance with legal requirements.
<br /> DATE 01/19/2012 F
<br /> 470
<br /> APPLiC ANT NAME(print) Chevron Products CoJjim HartmaII 471 APPLICANT TITLE Chevron Retail HEST-� 472.
<br /> UPCF UST-B Rev.(1212007)
<br /> TTO@ xKvd)40o sioiaaou NO2IAno 0999Zir M YVA CT:2T ZT0Z/6T/T0
<br />
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