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` AOL �J FIED PROGRAM CONSOLIDATED FO q' 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,11,III,IV,and IX below) 430. ❑ 1.NEW PERMIT E 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) _ 1. 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# 432�� 432. TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434. 3 k 7 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 ® la.MOTOR VEHICLE FUELING ❑ lb.MARINA FUELING ❑ Ic.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 [199.OTHER(Specify): 439a. ....................... CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED ❑ ]c.MIDGRADE UNLEADED ID lb.PREMIUM UNLEADED 440. ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑..._8.PETROLEUM BLEND FUEL............_0.._9.:._OTHER PETROLEUM(Specify):...... 440a. .............................................. NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 4406. 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 4`14 ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 44aa. ............................................................................................................................................_.............................................................................................................................................. ................... SECONDARY CONTAINMENT ❑ 1.STEEL ID 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 ID 2.DOUBLE WALL r_199.OTHER 460. ........... ........ ... ... ...... ......................................................................................._. SYSTEM TYPE ® 1.PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR§2636(a)(3)] 458. PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 1-0--.-R**IGID PLASTIC aha. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464a. ................................................................................................................................................................................................................................ ....................................................._. SECONDARY CONTAINMENT ❑ 1.STEEL ID 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464b. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c. ..........................................................................................................................................__.........._................................. ........................................................ PIPING/TURBINE CONTAINMENT SUMP TYPE ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 4644. 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): 464el. ......................................................................................................................................................................................_....................................................................................................................................................................................................................................................................................................................... VENT SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ID 90.NONE ❑ 99.OTHER(Specify): 6464f ......................................................................................................................................................................................................................... .................................................................................. .......... 464g. VR PRIMARY CONTAINMENT ❑ 1.STEEL ID 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 464 1,_____ ....... .. ... ......... ........__.................................................................................. .......... ....... - .. ....... .......................................................... . ._ (Specify): 464h1. VR SECONDARY CONTAINMENT ❑ L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ID 90.NONE ❑ 99.OTHER464h. .......................................................................................................................................................................................................................... ........................................................................................... VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ID 90.NONE 464'. ....... .......................................................................................................................................................... .............................................................:..........................................................................................................d64'...... .......................................................................................................................................................................... ............. RISER PRIMARY CONTAINMENT ID 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 664'1. ...............................................................................................................-.............................._............................................................................................................_._......................._..................... .1.......... ................................................................................................................................................................................ .. .... .. RISER SECONDARY CONTAINMENT [:11.STEEL ❑ 4.FIBERGLASS El 10.RIGID PLASTIC ID 90.NONE El 99.99.OTHER(Specify): 46641. ........................................................................-..................._................................................................................................................................................................................................................................................................................... FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET ID 3.STRIKER PLATE/BOTTOM PROTECTOR ID 4.CONTAINMENT SUMP 451a-c. VII. UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE ID 1.SINGLE WALL ❑ 2.DOUBLE WALL El 3.NO DISPENSERS [190.NONE 469a. ......................_.........._..._................................................................................................................................................................_.................................................................................................. 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 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:1FU0,WR97AEZ 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)