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U PMUD PROGRAM CONSOLTDATED FORM
<br /> UNDERGROUND STORAGE TANK s
<br /> OPERATING PERMIT APPLICATION-TANK INFORM*x ION
<br /> TYPE OF A(nON (Check one Wm only. For a UST Closure or romova4 4wVlete only this s utu;Cn d Scctions 1.d Ill.N,acrd LC below) 4i6.
<br /> ❑ 1,NEW PERMIT ® 3,RENEWAL PERMIT ❑ S.CHANGE ( AZ fM
<br /> El 6.TMOORARY UST CLOSURE [17.UST PERMANENT CLOSURE ON SITE S.LIST REMO 1
<br /> DATE UST PERMANENTLY CLOSED: 01 DATE EXISTING LAT DISCOVFRFD; a3ub.
<br /> . .. :....•. ..... •.. .•.: . L.-I'AC�,YTY.:•YN�'ORMATYON ..:.. ::::.• : . _;.. . ..,.: ..
<br /> FACILITY ID 9(Agency Use Only)
<br /> 1:11151NFSS NAME(utas as Facility Nance or DBA-Doing Business As)
<br /> �.
<br /> Chevron Station##201761
<br /> BUSINESS SITE ADDRESS 103. CTTY 1D4
<br /> 1103 S Main St Manteca,CA 95337
<br /> . . ... � .....-. ...::...,.::. :..:.......:... .....,..,.' ...;. :..... � •.D � C • • :::,'ION::.:�'-.'. ..;......,......... .:::•:...: • '::: .:::.;..... .::.:. . ,.,,...:.
<br /> : .. . . ...:... .. :>..:..: •:>:,. ..:: :•:• . .:•.•.: . ; .IL;..TANK ..FS RIFT . .. � _._
<br /> TANK IDS TANK MANUFACTURER 437 TANK CONFIGI,JRA-I•ION:THIS YANK 1$ 434.
<br /> ® 1.A STAND-ALONE TANK Complex one for each
<br /> EE�,
<br /> 2,ONE IN A COMPARTMENTED UNIT eamPonw,inunit
<br /> DATE UST SYSTEM INSTALLED 435• TANK CAPACITY IN GALLONS 436• NtJMF3HR OF COMPARTMENTS IN THE UNIT 437
<br /> 11/30/1992 12,000
<br /> III::'TAN >U E:'A►ND:.CONTENTS::: <:::_: ;:;::;:';;:::::: ::: ::::'::": ;::::::'::':;;:`:`::.:
<br /> TANK USE la MOTOR VEHICLE FUELING lb-MARINA FUELING la AVIATION FUELING : 439.
<br /> ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(wAwea Uwa oil) ❑ S.EMERGENCY GENERATOR FUEL Rrsc�2i291 s(c))
<br /> ❑ 6.OTHM GENERATOR FUEL ❑ 95.UNKNOWN ❑ ,99 QT11LR(5Re�ty); •.,._..._______._ 439a.
<br /> CONT 1iM S PETROLEUM: 19 Ia.REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED C) 1 b,PREMIUM UNLEADED
<br /> ❑ 3.Or6SEL ❑ S.JET FUEL ❑ 6.AVIATION GAS
<br /> ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM(Speeiry): 4404 _
<br /> __.._...._..___...NO N-P7M0LFUM; ❑ 7.USED OIL p 10,ri1 IANOL
<br /> ❑ 11.OTHER NON-PETROLEUM(S 460h
<br /> 7 77
<br /> . IV. TANS CONSTR..UCTION ....:.
<br /> TYPE OF TANK ❑ I.SINGLE WALL ® 2.DOUBLE WALL ❑ 95.UNKNOWN 443.
<br /> PRIMARY CONTAINNVICNT ❑ 1.STEEL N 3.FMEERGLASS ❑ 6.INTERNAL BLADDER 44
<br /> © 7.STEEL+rNTERNAL LINING ❑ 95.UNKNOWN ❑ 99,(YDIPR-Cy'pec-. ............................44:'°.-.-
<br /> SECONDARY CONTAINME, ❑ 1.STEEL ® 3.FIBERGLASS ❑ G.EXTERIOR hENMRANE TXNfik ❑ 7.JACKh'i*E0 445.
<br /> ❑ 90.NONE ❑ 95.UNKNOWN (] 99.OTHER(Specify): 445L
<br /> OVERFILL PRF:VF.NTION Q 1.AU131111,h'&V73UAl.AI.A)tMs ❑ -BALL FLOAT ® 3.FILL TUBE SHUT-OFF VALVE 4sz.
<br /> ❑ 4.TANK MEETS REQUIR Da-M FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT
<br /> :'I•:W` : �: `P. :IN.G.CONSTRUCT N;:;:=::::::;::::::`:'.':: .'':::.:;::::.:::• <: .,::..:;:
<br /> .. .' :..; . :....' .: . •.Y ::P�1�OD�U.CT.. ... AS'1'E .IP . . ...:
<br /> .: . ........ 'TSO ....
<br /> PANU(:UNSTRUCTION [] 1,SI.NGLC WALL ® 2,001,1131,14,WALL ❑...99:.O1'HF R($pe iFy): 460.
<br /> SYSTEM TYPE ® 1.PRESSURE _ L32.GR1�v27y ❑ 3 ' Ud VENT}ONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR 42636(&X3)1 463
<br /> PRIMARY CONTAINMENT ❑ 1.STEEL N 4,FIBERGLASS ❑ R.Fi-r)(IaLE p 10.RIGID PLASTIC 4".
<br /> _...,.............._...,,.:0..90.NOT .._..._....._...©...95.UNKNOWN ❑ 99.OTHER(SvwitY�:__.._..._..._ 464a.
<br /> 9F:CONDAkly CONTAINM6N'P ❑ t,STEEL M 4.FIr3ERGLASS ❑ 8.FLEXIBLE ❑ 10:(ICTID PLAST __...
<br /> le 464Ir.
<br /> ❑ 9o.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): Owe.
<br /> PIPING(nMINE CONTAI NNIENT SUMP TYPE IN 1.SINGLE WALL_ ❑ 2.DOUBLE WALL ❑ 90.NONE 464d.
<br /> VL.; ENT,;^VAI'.OIt:RECO. A►ND:RiSEI '/,FII L`P:IPtM1NG.:C.ONSTIIUCTIO I�
<br /> VKNT PRIMARY CONTAINMENT [II.STEEL ® 4.FIBERGLASS [I10.RIGID PLASTIC❑ 90.NONE❑ 99.07HER(Specify): 441e1.
<br /> VENT SECONDARY CONTAINMENT [11.STEEL[14.FIBERGLASS [110.RIGID PLASTIC® 90.NONE[I 99.OTHER(Spm*): 4644n1.
<br /> VR PRIMARY CONTAD34W T ❑ 1.STEEL 10 4.FIBERGLASS ❑ 10.RIGID PLASTIC❑ 90.NONE❑ 99.OTHER(Specify): 4ri4'.
<br /> VR SECONDARY CONTAINMENT [11.STEEL[34.FIBERGLASS C) 10,RIGID PLASTIC 8 90,NONE❑ 99.OTHER(Specify): 4601,
<br /> VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE,•WAIJ,❑ 2,DOUIiIA WALI, 90,NONE
<br /> RISER PRIMARY CONTAR*AENT ® '1.STEEL❑ 4.FIBERGI„ASS ❑ 10.RIGu3 Pi.AS'r1C Q 9n,NONE ❑ 99.OT11ER(Specify): u
<br /> _._.........._.........................................
<br /> ......_...__
<br /> RISER SECONDARY CONTA INMENT 0 1,STI--[;[, 4,FIIiHRGLASS ❑ 10.RIGM PLASTIC® 90.HONK ❑ 99(n'HFR 5pecir 404
<br /> FILL COMPONENTS INSTA 1,1,617) 1.5Pn.1. 3.STRIKER PLATE/BOTrOM PaoTBC•I-OR IM C CONTAii NIFISI�SIMV Osla o.
<br /> VII. :UNDER:DISFENSER CONTAItME . T{IJDC}
<br /> CONSTRUCTION TYPE ® 1,SINGLE WALL -❑'z•0008L:WALL Q 3.NO O15Pr',N$(,RS ❑ 90.NUNS 4e9a
<br /> CONSTRUCTION MATERIAL ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.R}GIDPLASTIC ❑ 99.OTHER(Specify) �
<br /> VIII
<br /> .
<br /> PROTECTION.'
<br /> STEEL COMPONENT PROTF,CTION ❑ 2.MACRIFICIAL ANOD3 (S) ❑ 4.11A RESSED CLIARENT _ CR 6.1S()LAI IWV 445.
<br /> J.
<br /> . :T::SIGl�ATUR:E.::`:!'�`'.M:��::~`u•::::: : ::',':.:::<�:`:,'•:;:":��M��::��M����:.::. :;;.:
<br /> CERTIFICATION:I certify that this UST System Is compatible with the hazardous substance stored and that the information prciv ded herein i8 true,
<br /> accurate,and In Pull compliance with legal requirements.
<br /> DATE 01/19/2012 aye.
<br /> A 12111 in a Ace 21
<br /> APPLIC ANT NAME(Print} Chevron Products C:o.ldim Hartman 471. APPLICANT 1Tfl.F, Chevron Retail HF,S':'m • 472'
<br /> UPCF UST-B Rev.(1:(2007)
<br /> noz AAi7JNOD SZD11011d NOUAM 0999Zir M Iva CT:ST ZT09/13T/T0
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