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( UNIFIED PROGRAM CONSOLIDATED FORM UNION UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION--TANK INFORMATION': lOnc form per us ) "YPE OF ACTION (Check one item oily. For a UST closure or removal,complete only this section and Sections 1,/1,111,IV,and IX below) 430. 0 L NEW PERMIT ® 3.RENEWAL PERMIT ❑ 5.C14ANGE OF INFORMATION 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 430.. DATE EXISTING UST DISCOVERED: 41nb I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) - 1. BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3 Chevron Station#249167 BUSINESS SITE ADDRESS0 CITY 104. 1234 Yosemite Ave Manteca,CA 95336 IL TANK DESCRIPTION TANK ID# 432. TANK MANUFACTURER 433 TANK CONFIGURATION:THIS TANK IS 434 �� 2 JtERXBS ® L A STAND-ALONE TANK c�piele one PW�ewh lt V ❑ 2.ONE IN A COMPARTMENTED UNIT aonPmt-m In tmunit DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMEN'T'S IN THE UNIT 417 1�r,•u 0 15,000 0 III. TANK USE AND CONTENTS TANK USE ® la.MOTOR VEHICLE TRIELING ❑ Ib.MARINA FUELING ❑ le.AVIATION FUELING 439 ❑ 3 CHIMCAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(ImIudes UAW Od) ❑ 5.EMERGENCY GENERATOR FUEL tHSC 125281 5(c)t (36.OTHER GENERATOR FUEL _ 1395.UNKNOWN 13 ".OTHER(Specify). 4398. C_ONT1iN__TS PETROLEUM: ❑ la REGULAR UNLEADED ❑ 1a MIDGRADE UNLEADED ® Ib_PREMIUM UNLEADED 440. ❑ 3 DIESEL ❑ S.JET FUEL ❑ 6 AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL _❑ 9.OTHER PETROLEUM(SSpecify): NON-PETROLEUM:[3D Q1L 7.USE110.1:T1iANOL 11.OTNER NON-PETROLEUM S 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 [395.UNKNOWN ❑ ".OTHER(Specify): 449a ECONDARY CONTAINMENT ❑ 1.STEEL 8 3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445. ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(Speaifjk 4451 ..�............-,-- _._ _ _ OVERFILL PREVENTION - 1.AUDIBLE&VISUAL ALARMS [12.BALL FLOAT 0 3.FILL TUDE SHUT-Off VALVE 432 4.TANK MEETS RE U1R1iMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT t WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ 1.SINGLE WALL 460 ® 2.DOUBLE WALL ❑ 99.OTHER_ -- _ SYSTEM TYPE - ® 1_PRESSURE ❑ 2.GRAVITY ❑ 3.GONYEb1TI0_N_A_L SUC770N ❑ 4.SAFE SUCTION(33 CCR§W34a)(3)) 458. PRIMARY CONTAINMENT ❑ 1 STEEL 0 4.FIBERGLASS ❑ B.FLEXIBLE ❑ 10.RIGID PLASTIC` 464 ❑ 90.NONE ❑ 95.UNI(NOWN ❑ 99.OTHER{Spxify): 464 _ SECONDARY CONTAINMENT ❑ 1.STEEL ®4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 4646_ _ ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): u4fift PIPINGM RINE CONTAINMENT SUMP TYPE ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 4S4d VI. VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT _ _® L. [31.STEEL 4.FIBERGLASS C310.RIGID PLASTIC ❑ 90.NONE E399.OTHER(Specify)' 464x1 VENT SECONDARY_CONTAINMENT^_❑ 1.STEEL 134.FIBERGLASS C310.RIGID PLASTIC ® 'm.NONE El99.OTHER(Specify): of VR PRIMARY CONTAINMENT _❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 9o.NONE_ ❑_99.OTHER(Specify): 46I 8p VR SECONDARY CONTAINMENT ❑ 1 STF.FI.. ❑ 4.FMERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHSR(Specify) 4601 VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE 4641 RISER PRIMARY CONTAINMENT _® 1,STEEL (❑ 4.FIBERGLASS ❑ 10 RIGID PLASTIC_❑ 90.NONE ❑ 99.OTIILER(Specify)'V � 464i_ RISER SECONDARY CONTAINMENT ❑ 1,STEEL Q 4 FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ( 99 OTHER(Speriry): 46�4k FILL COMPONENTS INSTALLED 0 1.SPILL BUCKET IN 3.STAINER PLATEMOTrOM PROTECTOR ®4.CONTAINMENT SUMP 451i'O- VII. UNDER DISPENSER CONTAINMENT(UDC) _CONSTRUCTION TYPE ® T.SINGLE WALL 1] 2 DOUBLE WALL O 3.NO DISPENSERS Ca 90790--w 4Ma. CONSTRUCTION MATERIAL ❑ 1.STEEL ® 4.FIBERGLASS [110.RIGID PLASTIC C399.OTHER(Specify) 469 VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2 SACRIFICIAL ANO S ❑ 4.IMPRESSED CURRENT 6.ISOLATION 448 IX. APPLICANT SIGNATURE CERTIFICATION:1 certify that this UST system is compatible with the hazardous substance stared and that the information provided herein is true, accurate.and in full coo tinuce with legal requirements. DATE 01/25aolo 410 APPLICANT NAME(print) Chevron Products CoJ JIM HARTMAN 471 APPLICANT TITLE Retail HES permit Desk 471 UPCF UST-8 Rev.(1212007)