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FIED PROGRAM CONSOLIDATED FO J .� o2jxqUNDERGROUNDSTORAGETANK OPERATING PERMIT APPLICATION-TANK INFORMATION (One form per 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: 4306. 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 Stockton, CA 95207 II. TANK DESCRIPTION TANK ID# fi ` -7-6j he'0 432. TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434. 2 XERXES ID 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. 01/01/1986 10,000 0 III. TANK USE AND CONTENTS TANK USE ID la.MOTOR VEHICLE FUELING ❑ lb.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 -[1 95.UNKNOWN ❑ 99.OTHER(Specify): 439a. _.._...__ ..........................................._. ...._.................................---......_..__....-..._._.................-_._.............................._.........._..... -- CONTENTS PETROLEUM: ® la.REGULAR UNLEADED ❑ lc.MIDGRADE UNLEADED ❑ Ib.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 ID 2.DOUBLE WALL ❑ 95.UNKNOWN 443. _...._........................._........................_............................................_.... ._.................................._.._............................_._......................................................................................................................................................................................-....._......-....._......._............................................................................................ PRIMARY CONTAINMENT ❑ 1.STEEL ID 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444. ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 444x. _..._................................._......._............................................_._..............................................................................._._..-........................................__......._._......_.................. .........................._........---..__.............................................. ............._...._..._..__..._._.- SECONDARY CONTAINMENT ❑ 1.STEEL ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445. ❑ 90.NONE _ ❑ 95.UNKNOWN El 99.OTHER(Specify): a45a.... - OVERFILL PREVENTION_.......................ID 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 ID 2.DOUBLE WALL ❑ 99.OTHER 460. ._..........._........................_._.._..__......_...._.................................................._... ---................._....._._.................................................................................................._................................_.._..----..............._.__._..-_.-........................................................................................................................................... . SYSTEM TYPE ® L PRESSURE El A 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION [14_SAFE SUCTION[23 CCR§2636(a)(3)] 458 PRIMARY CONTAINMENT. ❑ 1.STEEL ID 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464x. __ _-_...._......_.......... --._.................. _..__......................................---._...-........_............_..__.__.._.._..__ _.-.... -........... _ SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 4646. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c. ................_...__.....................................................................................__._..__.......................- ---........-.._.._....._........... i4N6 TURBINE CONTAINMENT SUMP TYPE ID 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE a6ad. VI. VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ® 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC [190.NONE El 99.OTHER(Specify): qq�j ..........................._..........-------._..................................__._..._........................................._._.._.......................................................................__.._..__......._......_....._.................................._._._.__........................._.... ---......................................................................................................... VENT SECONDARY CONTAINMENT [:11.STEEL ❑ 4.FIBERGLASS [310.RIGID PLASTIC ID 90.NONE [199.OTHER(Specify): a64ffi ......... ...................._........................................................................................_........_.-.._.................._ _...---............................................................................ ....._._._.. VR PRIMARY CONTAINMENT ❑ 1.STEEL ID 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): a5agt,...,., ......................................_..................................... _...._..-.--.-...................__........_.._......_.........._....._..........._.............................._......_....................................._.__._...........................__..._..._...._.._....._......-..........-_..............---.... VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ID 90.NONE ❑ 99.OTHER(Specify): 464hl. VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE _....................._ 4 ...._ .__........................_._...._- --............--........................_...........................................................................................................---...._ _............._._........------................................................................................................................................................................_.._............................... 4 RISER PRIMARY CONTAINMENT ID 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC [190.NONE [199.OTHER(Specify): g6gij. ............................................._....._........._..._....................._._.....-._...._._.................................__...--..........._.....---................_..---._._............................................................................................................................_..........---............._..----......._._.....---..................................... RISER SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ID 90.NONE ❑ 99.OTHER(Specify): 46akl. _............................_._.................................................................................................................................................._...__.._..................._........._................_..........................................................................................................................................................................................................._._........................................ ....................... FILL COMPONENTS INSTALLED ID 1.SPILL BUCKET ID 3.STRIKER PLATEBOTTOM PROTECTOR ID 4.CONTAINMENT SUMP 45la-c. VII. UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE ID 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 3_NO DISPENSERS , .0„_90.NONE 469x. ........._................................ ................_.. ............. .... .... ......... ....... .......................... __....._.--......... _........................................................ 469b. CONSTRUCTION MATERIAL ❑ 1.STEEL ID 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 469c. VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT 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:rF%EtDW4WNEZ 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)