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UNLRIED PROGRAM CONSOLIDATED FORM
<br /> UNDERGROUND STORAGE TANK
<br /> OPERATING PERMIT APPLICATION-TANK INFORMATION (one fonn per UST)
<br /> TY PF,OF ACTION (Check one item only. For a UST elwwra or remnval,emplete only thu section and Sections 1,Il,]/I,1V,:m d lX below)
<br /> ❑ I,NEW PERMIT ® 3.RENEWAL PERMIT ❑ 5.CHANGF.OP TNFQRMATIQN
<br /> El 6.TEMPORARY UST CLOSURE © 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL -
<br /> _DATE UST PERMANENTLY CLOSED: 4306. DATE EXISTING UST DISCOVERED:
<br /> .'':•�....::...,,., :�..;•-.,.`'`.:.;..:-,"�'`' `:`; .::'...:.:;:'.:.. .:I�`.::FACIIIT�Y:�IN•�.O ' TION'�;':''::�; '.:., . ,,::.• ;`.. ..:.:." ' ::..::...: :.::.':: ...�.:�..,::.:
<br /> .:..:. . ... .
<br /> FACILITY ID 4(Agency Use Oily)
<br /> BUSINESS NAME(SmneasracilttyNarnsorDBA DoingBusinew.4s) �� µ
<br /> Chevron Station#201761
<br /> BUSINESS SITE ADDRESS 103. CITY 104.
<br /> 1103 S Main St Manteca,CA 95337
<br /> :. .: ..... :.. YY. TPTIQN
<br /> ® 1.A STAND-ALONE TANK l compke nae page far each
<br /> TANK ID � 432. PANIC MANUFACTURER 433 TANKCONMGURATION:THIS TANK IS 434.
<br /> XERXES ❑ 2.ONE IN A COMPARTMENTED UNIT w-pal-m i n die urk
<br /> DATE UST SYSTEM INSTALLED +35. TANK CAPACITY IN GALLONS 41f, NUMBER OF COMPARTMENTS IN THF UNIT" 437.
<br /> 11/30/1992 12,000
<br /> :.A1�fiK USE:AN ..'.O..NTEN..TS: :. : ..
<br /> TANK USE N la.MOTOR VEHICLE FUELING Q I b.MARINA FUELING I e.AVIATION FUELING 430
<br /> ❑ 3.uEMICAL PRO.Dur--r li'l(MACh 4.HAZARDOUS WASTE flues Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL msc 425281.ww
<br /> ❑
<br /> 6.OTHER GENERATOR FUEL 95.UNKNOWN _.........................__......_.........❑. 99:1;7 I R($�ecify�_ 439x.
<br /> CON'I'F N'TS PETROLEUM: ❑ la REGULAR UNLEADED p 1c.M11)GRAW.UNLRAuEri Ib.PwimiuM UNLEADED 440,
<br /> E33.DIESEL. ❑ 5.JET FUEL ❑ 6.AVIATION GAS
<br /> ❑ S.PETROLEUM BLEND FUEL ❑ 9.OTHER PTMOLCUM(Specify): 440a-
<br /> NON-PETROLEUM: ❑ 7.USED OIL ❑ 10.ETHANOL
<br /> ❑ 11,OTHER NON-PETROLEUM(S +40k
<br /> "777777777777.77777.777.: .: , . ....,.;., .••:
<br /> - C .NSTRUCTIONc:
<br /> • . .............. .. ............ •7777.: •-..
<br /> I'V. TAl�tI ...c .
<br /> 7777. .. 7777. 7777 7777 ... ....... ... 7777.. ......... .....
<br /> TYPE OF TANK [] I.SINGLE WALL IN 2 DOUBLE WALL ❑ 95.UNKNOWN 443.
<br /> PRIMARY CONTAINMENT ❑ I.S rr:t:]. 3.FTBERGLASS ❑ 6.INTERNAL BLADDER 444.
<br /> $RNALLININC ❑ 95.UNKNOWN ❑ 99.OTHER(SPcarfy): aa4e
<br /> SECONDARY CONTAINMENT 0 1.S,M-m, Is 3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445-
<br /> _ ❑ 90,NOMI ❑ 95.UNKNOWN 0 '>9:
<br /> AV�RTl1LL PREVENTION ❑ 1.AUDIBLE&VISUAL ALARMS 13 2.BALL FLOAT ® 3.FILL TUBE SHUT-OFF VALVE 452
<br /> ❑ 4.TANK MEETS REQUMEAENTS FOR EXEMPTION rROM OVGRrIL1,PR,HVDMON r•, 1JIPMtiN'r
<br /> •,/.;. . .:.:. 7777.., . 7777,, . . . . ... . . .. ., ,.,.......:..:
<br /> ' RODITCT WASTE.PYI'ING CONSTRY7CTXON
<br /> PIPING CONSTRUCTION ❑ 1.SINGLE WALL ® 2,fX)l]aLli V/AT L ❑ 99.OTHER S :
<br /> 460.
<br /> SYSTEM TYPE ® 1.PRESSURE ❑ 2.GRAVITY .....__,.._0_'_CONVENTIONAL SUCTION-O 4.SAFE SUCTION r23cCRm6wmi 459•
<br /> PRIMARY IN
<br /> CONTAMENT ❑ 1.STEEL ® 4.FJSI;PGI.AS$ ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464.
<br /> ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.(PrHER(Specify): 4616.
<br /> SECONDARY CONTAINMENT ❑1.STI,r 1. 1M 4.FIBERGLASS ❑ S.FLEXIBLE ❑ 10.RIGIDPLASTIC
<br /> ❑ 90.NONE: ❑ 9S.UNKNOWN -[1..'99 OTHER.(Specify): 4640.
<br /> P1PIN(ifl-URBINE CONTAINMENT SUMP TYPE ® 1.SINfjLL WALL E32.DO[lBLE WALL ❑ 90.NONE � 464d
<br /> ':7,777,:.;7,777; .. ..•,•...:.... ..... .:.. ...7777. .;..7777. ;....:...:....,.;.. ...
<br /> VI:; PENT,VAPOR RECOYE.It ';{VR):AND'RISER/:FILL•PIPE PIPING.CC�NSTRUCTIO.:N.'
<br /> VENT PRIMARY CONTAINMENT ❑ LSTEEL 1`31 4.FIBERGLASS ❑ 10.RIGID PIASTIC❑ 90.NONE❑ 44.OTHER(Specify): 4W.
<br /> I..","",.........._...._.....I......_......_.......
<br /> V15N'I'SFCO'NOARY CONTAINMENT ❑ 1.STEEL❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC a 90.NONE❑ 99.OTHER(Specify): 464n•
<br /> VK P1tIMARY CONTAINMEN T ❑ 1.STEEL N 4.FIRI;Rt=].ASS ❑ 10.RIGID PLASTIC❑ 90.NONE❑ 99.OTHER(Specify):
<br /> VR SECONDARY CONTAINMENT [31,317 Fl.❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC 10 90.NONE❑ 99.OTHER(Specify): 4iah
<br /> VENT PIPING TRANSITION SUMP TYPF ❑ 1.SINGLE WALL❑ 2.DOUBLE WALL N 90.NONE
<br /> -...............................__.._ ��..6,
<br /> 9641.
<br /> RISER PRIMARY CONTAINMENT 0 i'STyn❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC❑ 90.NONE ❑ 99.OTHER(Specify): aa4j]
<br /> RISER SECONDARY CONTA INMENT O L$1-FEL❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC® 90.NONE ❑ 99.OTHER(Specify): 4o4k1.
<br /> FILL COMPONENTS INSTALLED -®....1•SNI1.L ISuciKEr ® 3.STRIKER PLATEBOTTOMPROTECTOR ® 4.CONTAINMENT SS-IMP
<br /> 77,77. ... 7777,: 7777 :: �y;:i•(';;t:^:,.:;�:?:;;•::.;� � :. � . . ...
<br /> . ..`...,... ... . • 7777 ,
<br /> .:VII::::..UN'DER:'DISPENSER
<br /> CnNSTRUCTION TYPE ® 1.SINGLE WALL - ❑ 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.N%f. 4692
<br /> CONSTRU(.rIQN MATERIAL ❑ 1.STEEL 1@ 4.FIBERGLASS ❑ l0,xiGlD VIAS fK: ❑ 99,OTI.11ix(Spwiry) ��
<br /> +
<br /> 7777. �.•. ' . .RROSION:PR4'TECTION:`:'
<br /> STRF.I.MMPONBNT PROTE CTION Q 2.SACRIFICIAL ANdDF.(SL,._ [1 4.IMPRESSED CURREN'T ® 6.ISOLATION
<br /> .:4 ::�.:...::.:.,.•:..'.'":...:.••"""""."'.T_.....•::.:.•.::..:•:.�:::•.:.�...:..;.,7777:•7777:• 7777 : 7777 � .......::;�.:�:>.,•.::..;>;.:...:.>..:::;:::.;. :i:'..;K:r:;.:::i.:;,.,;:.,...,�,•.:•:..•.�•x.;'
<br /> 7777:' '.:I7 ; APPLICANT:SICNAT:hRE
<br /> CF.RTIFI(ATION: 1 certify that this UST system is compatible with the bazardons substance stored and that the information pFbided herein is true,
<br /> accurate,and in fall cam-eliance with Ie%W regairements.
<br /> DATE 01/19/2012 47
<br /> APPI 1C ANr NAME(print) Chevron Products Cod Jim Haran - 411. APP1.ICANI"rn'I.F Chevron Retail 14F,S 472
<br /> _7777:-
<br /> UPCF UST-8 Rev.(12/!807)
<br /> CTO[P] ANVdROD SZDMOHd NOHAm 099MRSE6 %V3 bT:5T ZTOZ/6T/TO
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