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A#_ IED PROGRAM CONSOLIDATED FO ` 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: 43W I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) - - 1. BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3. Chevron Station#208118 BUSINESS SITE ADDRESS 103. CITY 104. 3355 E Hammer Ln Stockton, CA 95212 II. TANK DESCRIPTION TANK ID# 432 TANK MANUFACTURER 433 TANK CONFIGURATION:THIS TANK IS asa. � �5'35 4�_ 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. 07/15/1999 15,000 0 III. TANK USE AND CONTENTS TANK USE ® la.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ lc.AVIATION FUELING 439. ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§25281.5(c)] _T ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 439x. ...... ...................................-..._....-.------..........------........................................................................................,..�......�............................................_....._........._... ....................... CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED ® lc.MID-GRADE UNLEADED . PREMIUM UNLEADED 440. ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 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 ® 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. ............................ --._............ SECONDARY CONTAINMENT ❑ 1.STEEL ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445. ❑ 90.NONE ❑ 95.UNKNOWN [:199.OTHER(Specify): 445a. _...._..._......._-_._.__............_...._.............................._._........_.........................................._.._.........._.....................-- .._._................_.-.._......_.. OVERFILL PREVENTION ® 1.AUDIBLE&VISUAL ALARMS ❑ 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 ❑ 99.OTHER 460. _-__..._................._..........__........_......_........_. ............._.................................................._..............................................._..........._.........._......------........__....._._..._..................................................................................................................................................................................................................................................................458.... .. SYSTEM TYPE _......_.__..........._® l.:PRESSURE -3 2,GRAVITY ❑ 3.CONVENTIONAL.SUCTION.....Q..._4:..SAFE SUCTION[23 CCR§2636(a)(3)]..................................._._ PRIMARY CONTAINMENT E I.STEEL ® 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 a64b. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c. PIPING/TURBINE CONTAINMENT SUMP TYPE 0 "1".'S I N G L E WALL ❑ 2.DOUBLE WALL ❑ 90.NONE a6ad. VI. VENT,VAPOR RECOVERY(VR) AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ® 1.STEEL [14.FIBERGLASS [110.RIGID PLASTIC [190.NONE [14644.99.OTHER(Specify): 46441. ..................................................................................................................................................._-..........._....._._.-._...................-_......._.._....__..................._................................................................................................._-..............._.--............................_................................. ........ ....................... VENT SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 4644 VR PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS [110.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 4 Wig. ................._...._.........................................................._..._.__................_.... __._......... -...._............................................................._..........................................._._..._......_..._............__._..--_...........................-........................................_.__................................................ 464h. VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 464h1. -................._......_...._._.-.__..................._......._................................................_......._...........................-...... _................ _..... __...............................................................................................................................................-.................. _...__................ VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL [__1 2.DOUBLE WALL ® 90.NONE ate' ....................................._.._._............................_.__............................-._................__............._..........._.............._.._..........-._..._..__..................................._._......................................................................................................._................. 4 :-..._ RISER PRIMARY CONTAINMENT ® 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 464�jj. ....................................._............... ....................................._...._.._...................._...._----.--_._......__._.._......................._........._................................... ... .... RISER SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 4664kl. ....................._._............._...................................._..---..........................._.-_..................................................................................__.._..........................._ ..............._..............__.................................................................................................................................FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET ® 3.STRIKER PLATEIBOTTOM PROTECTOR ® 4.CONTAINMENT SUMP 45la-c.... VII. UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ® 1.SINGLE WALL................................................._................_El 2:._DOUBLE WALL................_0__3:._NO DISPENSERS..................._ .._90.:_NONE.................................._469a. _ .......................... ......... .... 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 t 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:FUD WAR,27.9VEZ DATE 01/13/2009 470 APPLICANT NAME(print) Chevron Products Co./FRED MARTINEZ 471. APPLICANT TITLE Chevron Retail HES Permit Desk 472 UPCF UST-11 Rev.(12/2007)