COMPLIANCE INFO_2011-2015 - Laserfiche WebLink

Home Browse Search

UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION (Onc form per us,) /'_ 430 Y-PE OF ACTION (Check one item only. For a USTClasnre or removal.complete only this section and Sections!, A ltl,IV,cold INF below) ❑ I NEW PERMIT IFS 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE OATEN SITE UST DISCOVERED:8.UST REMOVAL a10b. DATE UST PERMANENTLY CLOSED- 430a I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) BUSINESS NAME(Some as Facility Name or DBA-Doing lushness As) Chevron Station#209167 BUSINESS SITE ADDRESS 103 CITY �� 1234 Yosemite Ave 14tanteca, CA 95336 H. TANK DESCRIPTION TANK ID# _ 432. TANK MANUFACTURER 433 TANK CONFIGURATION:THIS TANK IS 434 `A o ' ) `' �2 � XERXES ® 1.A STAND-ALONE TANK ca mpl etc wx page for each T J J ❑ 2.ONE IN A COMPARTMENTED UNIT �mPm-in uu unit. DATE UST SYSTEM INSTALLED 433 TANK CAPACITY IN GALLONS 416 NUMBER OF COMPARTMENT'S IN THE UNIT d77 �p -1-0 20,000 0 III. TANK USE AND CONTENTS TANK USE ® la.MOTOR VEHICLE FUELING ❑ lb.MARINA FUELING ❑ le.AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(twhUda Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL IHSC 125281.5(e)I _ [36.OTHER GENERATOR FUEL 1395.UNKNOWN ❑ ".OTHER(Specify) 439x. CON"['Ir'NT S PETROLEUM: la.REGULAR UNLEADED ❑ la MIfIGRAt)F.IINLEADED_� ❑ lb.PREMIUM UNLEADED 440 ❑ 3.DIESEL ❑ 5.JET RL ❑ 6.AVIATION GAS ____❑ a.PETROLEUM BLEND FUEL 0 9.OTHER PETROLEUM(Specify): -_ NON-PETROLEUM❑ T.USED OIL to.LTHANOL _ - 11.OTHER NON-PETROLEUM eci ; 440b. IV. TANK CONSTRUCTION TYPE OP TANK ❑ 1.SINGLE WALL ®2.DOUBLE WALL ❑ 95.UNKNOWN-- _ -�,a---_443 PRIMARY CONTAINMENT - ❑ L STEEL ® 3 FIBERGLASS ❑ b INTERNAL BLADDER 443 --❑ 7.STEEL}INTERNAL LINING -- ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 4448. "IECONDARY CONTAINMENT ❑ 1.STEEL Is 3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED _ El 90.NONE 13 95.UNKNOWN C199.OTHER(Specify): 44$8 OVERFILL PREVENTION_ _.____ _ I.AUDIBLE R.VISUAL ALARMS [12.BALL FLOAT ® 3.FILL TUBE SINT-OFF VALVE °52. 4 TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL-PREVENTION EQUIPIVENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ 1.SINGLE WALL 0 2.DOUBLE WALL ❑ 99.OTHER -_ 460. SYSTEM TYPE __---�0 1.PRESSURE ❑ 2.GRAVITY [33-CONVENTIONAL SUCTION [34.SAFE SUCTION(23 CCR jM36(■X3)) 458 PRIMARY CONTAINMENT- ❑ 1 STEEL---- 0 4.FIBERGLASS ❑ 8-FLEXIBLE ❑ 10.RIGID PLASTIC 464 _ ----❑ 90.NONE -----[195.UNKNOWN - ❑ 99.OTHER(Specify): 464a. SECONDARY CONTAINMENT [a i.STEEL 29 4.FIBERGLASS 0 8.FLEXIBLE ❑ 10.RIGID PLASTIC 46ab-- __ _❑ 90.NONE ❑95.UNKNOWN ❑ 99-OTHER(Specify). 464c. PIPING/TURBINE CONTAINMENT SUMP TYPE ® 1.SMLE WALL 132.DOUBLE WALL [390.NONE 464d_. VI. VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT 13 1 STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90,NONE ❑ 99,OTHER(Specify): 4C6et' VENT SECONDARY CONTAINMENT ❑ t STEEL ❑ 4.FIBERGLASS ❑ 10 RIGID PLASTIC ®90.NONE ❑ 99,OTHER(Specify). A"n _ _ - �- . �- VR PRIMARY CONTAINMENT -❑ 1.STEEL IN 4.FIBERGLASS ❑ 10 RIGID PLASTIC fl 90_NONE ❑ 99._OTHER(Spa_ify): _46 1 4_18VR SECONDARY CONTAINMENT [It STEEL ❑ 4.FIBERGLASS _❑ 10 RIGID PLASTIC_® 90_NONE ❑ 99.OTHER(Specify) 4 " VENT PIPING TRANSITION SUMP TYPE ❑ 1 SINGLE WALL ❑ 2 ROUBLE WALL ®90 NONE 464i _ _ _ 464 . RISER PRIMARY CONTAINMENT - M L STEEL ❑ 4.FIBERGLASS ❑ to.RIGID PLASTIC ❑ 90 NONE ❑ 99.OTHER(Specify)~ �L'jf 47--- - - -- RISER SECONDARY CONTAINMENT ❑ 1,STEEL ❑ 4.FIBERGLASS [310.RIGID PLASTIC 0 90.NONE El 99.OTHER(Spccify). 4664k1 FILL COMPONENTS INSTALLED ISI 1.SPILL BUCKET N 3.STRIKER PLATEIRO TOM PROTECTOR ® 4.CONTAINMENT SUMP 'S VIL UNDER DISPENSER CONTAINMENT(UDQ CONSTRUCTION TYPEISI 1.SINGLE WALL_ N 2 DOUBLE WALL 0 3.NO DISPENSERS ❑ 90.NONE 4694 CONSTRUCTION MATERIAL - 13 t STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC y ❑ 99,OTHER(Specify) 4 VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANDD S ❑ 4.IMPRESSED CURRENT 6 ISOLATION 449 IX. APPLICANT SIGNATURE CERTIFICATION- I certify that this UST system Is compatible with the hazardous substance stored and that the information provided herei is true, accurate and in full compliance with legal rc uireme0ts, +i DATE 01125/2010 470 APPLICANT NAME tint 491' APPLICANTTITLE '* a9z (print) Chevron Products CnJIIM HARTMAN Retail HES Permit Desk UPCF UST-B Rev.(1=407)