COMPLIANCE INFO_2007-2009 - Laserfiche WebLink

Home Browse Search

Aft FIED PROGRAM CONSOLIDATED FORW 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,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: 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 Stockton, CA 95207 II. TANK DESCRIPTION TANK ID# 432. TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434. 2 XERXES ® 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 ❑ 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): 439x. _....__. .. ............................................................................_........................-_....._.................._..__....__......._....._............._....__..... ....................... CONTENTS PETROLEUM: ® la.REGULAR UNLEADED ❑ 1c.MIDGRADE UNLEADED ❑ lb.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 ® 2.DOUBLE WALL ❑ 95.UNKNOWN -............._..........................................._. 443. ................................................................................................................................_...._...._..........................__.-................................................................_._.._........_..---. .... _ .................................................................................................................................. ....._.-..............................................._........... PRIMARY CONTAINMENT ❑ 1.STEEL ® 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444. ❑ 7..STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 444a. _.....-_.............................--- .................,..........................................................................._............................................. - ...._................._...... SECONDARY CONTAINMENT ❑ 1.STEEL ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445. ❑ 90.NONE ❑ 95.UNKNOWN [199.OTHER(Specify): 445a. _._................... ......................_.......................................................................................__....._........u..._._.........._............_..._.._.._................_._._ ................... OVERFILL PREVENTION ® 1.AUDIBLE&VISUAL ALARMS ❑ 2.BALL FLOAT ® 3.FILL TUBE SHUT-OFF VALVE ❑ 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(a)(3)] 458. _ ................ .__...... __...._....................-_........_.......... ..................... PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC aha. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 46aa. _..........................._......._..-_._._......................................................................................................._..--................--..__........._..-... ._................ _.. 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 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 ® 90.NONE ❑ 99.OTHER(Specify): 464fl ............................................................................................._._.............__. _...............__.__...-..................-................................................................................................................................................................._.-.-......_---..........................................................--- .................... 464g. VR PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 40gt 464h. VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 4601. ...................... VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE 464'. ....................................................._................................................_._......_..........................._..-._...._..._......._................................................................_...._............................................................._.........._..........................................._........................._......_......._......---.._...._................................................................................................. . RISER PRIMARY CONTAINMENT ® 1.STEEL El 4.FIBERGLASS 10.RIGID PLASTIC El 90.NONE [1 99. 4641. OTHER(Specify): g46j1. ................................................................................................................._..........._.-........_._..................................._....._......................---..._.............. ............................................................................. . . . RISER SECONDARY CONTAINMENT [11.STEEL [__14.FIBERGLASS [110.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 46akt. _.........................---..__............................__.................___._......_.................................................................................................................................................._.._...__.................... ...................................__.... ....................... FILL COMPONENTS INSTALLED ® t.SPILL BUCKET ® 3.STRIKER PLATE/BOTTOM PROTECTOR ® 4.CONTAINMENT SUMP 45ta-c. VII. UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE ® 1.SINGLE WALL..................................................................._[:1 2 DOUBLE WALL................_El 3:.NO DISPENSERS.._..._....._[1 90.NONE...................... 469a. ..........._.4_...i_... CONSTRUCTION MATERIAL ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) %,, 469c. VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLA 448. IX. APPLICANT SIGNATURE CERTIFICATION: I certify thayNs UST system is compatible with the hazardous substance stored and that the info rdAt provided herein is true, accurate,a in ll hmpliance with legal requirements. APPLICANT SIGNATURE: UA DATE 06/10/2009470 472, APPLICANT NAME(print) Chevron P o is Co./JIM HARTMAN 471 APPLICANT TITLE Retail HES It Desk UPCF UST-B Rev.(12/2007)