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1110� FIED PROGRAM CONSOLIDATED FO -;7/2-3 �� 4430. UNDERGROUNDSTORAGETANKOPERATING PERMIT APPLICATION-TANK INFORMATION (one formTYPE OF ACTION (Check one item only. For a UST closure or removal,complete only this section and Sections 1,11,III,IV,and IX below) ❑ 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: 430x. I DATE EXISTING UST DISCOVERED: 430b. I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3. Chevron Station# 96171 BUSINESS SITE ADDRESS 103. CITY 104' 6633 Pacific Ave I Stockton, CA 95207 II. TANK DESCRIPTION TANK ID# -� J7 Z� cam' 432. TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434. 1 XERXES S l.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. 01/01/1986 10,000 0 III. TANK USE AND CONTENTS TANK USE S la.MOTOR VEHICLE FUELING ❑ 1b.MARINA FUELING ❑ lc.AVIATION FUELING 439. ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§25281.5(c)] ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 439a. ---.................... .............................................. --._.._. _..._......_........_._...__..............................................................................................................................................................._ CONTENTS PETROLEUM: ® la.REGULAR UNLEADED ❑ lc.MIDGRADE UNLEADED ❑ lb.PREMIUM UNLEADED 440. ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS - -'--._............_ ...............................-._.........._0..._8.._PETROLEUM BLEND FUEL 9..OTHER PETROLEUM(Spe65.,._ 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 S 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444' ❑ 7.STEEL+INTERNAL LINING [195.UNKNOWN [199.OTHER(Specify): 444a _...__.................. ......................................................................._.........................._-..................._............................................................................................................................................................ ------_...... SECONDARY CONTAINMENT ❑ 1.STEEL S 3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445 ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specify): 445x. _........._.._._ _._........__..................._............ ......... .................................._._...................._............._._..--.._._.._......_.._. -.. __......_ ............................. 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 S 2.DOUBLE WALL ❑ 99.OTHER 460. _ ..........................._.._....._.._..._..._._..._........................._.........................................................................................................................................................................................................................................................................................._ TIN 4.SAFE SUCTION 23 CCR 2636 a 3 458. 2 RAVITY 3.CONVENTIONAL SUC O _SYSTEM TYPE.............................._.................................®....1.:..PRESSURE....................❑�G _ ❑ D...................---................._._............._(_..._..._......_§_.(.)(_)]_..._...._......--- PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464a. -'- _.................................... . ...... _ --.-.._..... SECONDARY CONTAINMENT ❑ 1...STEEL..................................5...4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 4646. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c. ...............................................--'-._........_.................._............................-' -._................................................................................................................................................................_..._........_......._- ........ PIPING/TURBINE CONTAINMENT SUMP TYPE S ].SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464d. VI. VENT,VAPOR RECOVERY(VR) AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ® 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 4464e1. ..............................................__._......................................................................... .. ._.---............._.............................................................................................._..........-..................._._...._...._......................_..............................._ - VENT SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGIDPLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 464fl ...................._..._..-'---.......................................__...................._.........._............................................................................__ _................ VR PRIMARY CONTAINMENT ❑ 1.STEELS 4.FIBERGLASS ❑ 10.RIGIDPLASTIC [390.NONE [199.OTHER(Specify): 44441. .............._........_.._...._............................................................................__...._.............._.-.._............................_.............._._..-.---...........--..._........................................................................................................................... VR SECONDARY CONTAINMENT [__11.STEEL [14.FIBERGLASS [110.RIGID PLASTIC S 90.NONE [199.OTHER(Specify): 4464h1. _.....--......_.._......__....__...._._._......._.........__...._..................._...........----....................__..__..................................................................................._.................................- -- ..................................._......................................._................................................. VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL S 90.NONE 464r ..................................................--...-.......................................---._...................-........._.......-.....................................................................................__............................._-._.........__' _._.._..............................................................._.................................._.................................................................................._fi..._...... RISER PRIMARY CONTAINMENT S 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 46641;..,,,. .............................._._.....__..._.._...._...----- ._..._........._......._.........................................__...__................................_...................................._._.._....._........................................_.................._......_..---....._..._......__........................... 464k. RISER SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS [110.RIGID PLASTIC S 90.NONE [199.OTHER(Specify): 464k1. ..._............_.........................................................................................................................................__._....._...---......_........._......_...................................__.--.._...-.._._.._.....................................................................................................................................--'-._......_............... FILL COMPONENTS INSTALLED S L SPILL BUCKET S 3.STRIKER PLATE/BOTTOM PROTECTOR S 4.CONTAINMENT SUMP 451a-c. VII. UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE S 1.SINGLE WALLS 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469x. ............. ..................._........................................._................................................................................................................................................................................................__..._._.........._............................._............................................._................................................................................................................................................................_....466. ---' CONSTRUCTION MATERIAL El I.STEEL S 4.FIBERGLASS [I10.RIGID PLASTIC [199.OTHER(Specify) 469 VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT 6.ISOLATION 448. M 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:FP0,11,ARVJVrEZ DATE 01/12/2009 470. APPLICANT NAME(print) Chevron Products Co./FRED MARTINEZ 471. APPLICANT TITLE Retail HES Permit Desk 472 UPCF UST-B Rev.(12/2007)