COMPLIANCE INFO_2007-2009 - Laserfiche WebLink

Home Browse Search

FIED PROGRAM CONSOLIDATED FO r UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION tone for{ UST) TYPE OF ACTION (Check one item only. For a UST closure or removal,complete only this section and Sections I,A 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: 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. 1 CITY 104. 6633 Pacific Ave Stockton, CA 95207 II. TANK DESCRIPTION TANK ID# 432. TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434. 1 XBRXES ® 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 43z 01/01/1986 10,000 0 III. TANK USE AND CONTENTS TANK USE ® la.MOTOR VEHICLE FUELING ❑ lb.MARINA FUELING ❑ lc.AVIATION FUELING 432 ❑ 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: ® ]a.REGULAR UNLEADED ❑ lc.MIDGRADE UNLEADED ❑ ib.PREMIUM UNLEADED 440. ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑„-8,.PETROLEUM BLEND FUEL 0 9:OTHER PETROLEUM_(Spe!off 440a..:..........- -- ._......._.....__....._..............._......... -..__.._..__....... ..... ........................................... NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 440b. IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE W_ALL ® 2.DOUBLE WALL ❑ 95.UNKNOWN 443. PRIMARY CONTAINIv1ENT ❑ 1.STEEL ® 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444. ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 444a. ......................_.........................................................................-...---.....--...................................._...._............................................................................_................... ..............................................._.. SECONDARY CONTAINMENT ❑ I.STEEL ®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 ® 2.DOUBLE WALL ❑ 99.OTHER 460. _.............................-_..._.....-..._........................................................................................................................................................................._......_...._........................................................_..---............._._....._...._._._........_....................... SYSTEM TYPE ® 1.PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR§2636(ax3)] 458. ........................................_....__......................................_.................---------................................................................_... - ....................................................................... -...-...._.._....._......_......_.............-- PRIMARY CONTAINMENT ❑ L STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464a. ....................-.....__...__._._..............................._.............................................-_..............................................................._.._._-......................................-.._._..- - - _._.__-..... __......._......_.._.._........ _ SECONDARY CONTAINMENT ❑ 1.STEEL ® 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 464d. VI. VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ® 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE [1 99.OTHER(Specify): 464el. _.-_................................................................................_......_._._.................................__........._......................._._._...............................-_._.....----............................................................................................................................................__..._.......---..._.................... ..................... VENT'SECONDARY CONTAINMENT 1--] 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90:NONE C] 99.OTHER(Specify): 4648 ............................................_.........................._..---..._... _................._............................................................................................................................................_._................................ ....................... VR PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): q Wig_ 464h. VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE [199.OTHER(Specify): 464h1 _.._...----... ...-_��.- -.....----.........................................................................__._............................._...__._.._.......................----..........__.............................................................................-.. . . _............._-...._.......................................................................... i.... VENT PIPING TRANSITION SUMP TYPE [11.SINGLE WALL [:12.DOUBLE WALL ® 90.NONE ............................................__._..._..._........................-_..._.........---....................._..............................---._....._..............._...._._................................................................................................................_.._........_._....._-.-._............__..................................._................................................................................................_._.4�...... RISER PRIMARY CONTAINMENT ® 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 4641..,.,., ......................................................................................................_...................................................-..........._........ _..................__.._...................................................................................................................................._........_-..... ---.................................._............................................. RISER SECONDARY CONTAINMENT [11.STEEL [14.FIBERGLASS El10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): a64k1. FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET ® 3.STRIKER PLATE/BOTTOM PROTECTOR ® 4.CONTAINMENT SUMP VII. UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE 01.SINGLE WALL ® 2.DOUBLE WALL El 3.NO DISPENSERS [190.NONE 469a. ...._.._....._.._..-----...............................-----..._.............................................................................................................................. ................._......................_.---..............................................................................................................................................................._.....................................................................................69........ 4 . CONSTRUCTION MATERIAL ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC [199.OTHER(Specify) 469c. VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION 448. IX. APPLICANT SIGNATURE CERTIFICATION: I certifyatthN UST system is compatible with the hazardous substance stored and that the informatio ayided herein is true, l accurate, in f com liance with legal requirements. 0. APPLICANT SIGNATURE: DATE 06/10/2009 ► 47 r. APPLICANT NAME(print) Chevron r /JIM HARTMAN 471, APPLICANT TITLE Retail HES P?!.., ' Desk 472 UPCF UST-B Rev.(12/2007)