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Ask Am l' 1 0=0 ITKIFIED PROGRAM CONSOLIDATED FORM, e - UNDERGROUND STORAGE TANK c� OPERATING PERMIT APPLICATION - TANK INFORMATION (one Orm per TYPE OF ACTION (Check one item only. For a UST closure or removal, complete only this section and Sections I, A III, II , and IX below)430. ® 1. NEW PERMIT [13. RENEWAL PERMIT [:15. CHANGE OF INFORMATION G �1P` `)P ❑ 6. TEMPORARY UST CLOSURE ❑ 7. UST PERMANENT CLOSURE ON SITE ❑ 8. UST REMOVAL DATE UST PERMANENTLY CLOSED: 430a. 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# 307709 BUSINESS SITE ADDRESS 103, CITY 104. 10858 Trinity Parkway Stockton, CA 95219 II. TANK DESCRIPTION TANK [D # D S(s./ 432. TANK MANUFACTURER a33. TANK CONFIGURATION: THIS TANK IS 434. 1 C� 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. 07/01/2007 20,000 0 III. TANK USE AND CONTENTS TANK USE ® Ia. MOTOR VEHICLE FUELING ❑ Ib. 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: ® 1 a. REGULAR UNLEADED ❑ lc. MIDGRADE UNLEADED ❑ lb. PREMIUM UNLEADED aao. ❑ 3. DIESEL ❑ 5. JET FUEL ❑ 6. AVIATION GAS 8. PETROLEUM BLEND FUEL 9. OTHER. PETROLEUM (Specify): 44o.a _ ....................❑ _......_..............._............................._ NON -PETROLEUM: ❑ TU S E D OIL ❑ 10. ETHANOL ❑ 11. OTHER NON -PETROLEUM (Specify): 4406. IV. TANK CONSTRUCTION TYPE OF TANK❑ 1. SINGLE WALL ® 2. DOUBLE WALL [195. 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 ❑ 99.OTHER (Specify): 445a. _........................................................._....................................................._....__..................................................._.....__..................................._....-_.._-..._...._..-.. - --- OVERFILL PREVENTION ® I. 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. _.__......-.._..---......._.......... ....._.. - -......__...........................__................_............................__............................................_............................ - ........ ---._.-........................................................ ..........................................._._._..---. EM l . 4. SAFE SUCTION [23 CCR §2636(a)(3)] . SYSTTYPE ® PRESSURE ❑ 2. GRAVITY [13. CONVENTIONAL SUCTION ElS _...._.........................-- --........_...._..__..........--._.._.._.. - -..............................................................................................................................._..............._..........................._................__..........................................................._.... PRIMARY CONTAINMENT ❑ 1. 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 a6ad. 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): 464e. 464..1. ........................................._..........................................-........_........_._._...-------_...................._...................... .._....._... ...... ----.._....._............................__...._..._._._....................................................................._..................................................._-..................................................._._... VENT SECONDARY CONTAINMENT ❑ 1. STEEL ® 4. FIBERGLASS [:110. RIGID PLASTIC [190. NONE ❑ 99. OTHER (Specify): 44 ....----................................._...._..---....----.._...__........_....__.._.._................ - VR PRIMARY CONTAINMENT _ ❑ l_ STEEL ® 4. FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 90. NONE ❑ 99. OTHER (Specify): 464 1. ... ................---._..__._..._.........__........................_............................................_......................................... -- --- ..._.._......-- ------............................_................. VR SECONDARY CONTAINMENT [11. STEEL ® 4. FIBERGLASS El 10. RIGID PLASTIC [:190. NONE [199. OTHER (Specify): 4 464h. P 64h l . VENT PIPING TRANSITION SUMP TYPE ❑ 1. SINGLE WALL ® 2. DOUBLE WALL ❑ 90. NONE 464' ................._......................................................_....__...._-__..............................................................................................................................................................................................................................................................................................................................................................................................._...---.._.._.._.. 4�._.. RISER PRIMARY CONTAINMENT ® I . STEEL ❑ 4. FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 90. NONE ❑ 99. OTHER (Specify): 464 j ................................................................._-_._............................_-.._....._.._...._.......................__................................................................................................ ...................................._...................................................................................................................................................................... ....._...1- 464k. RISER SECONDARY CONTAINMENT ❑ 1. STEEL ❑ 4. FIBERGLASS El 10. RIGID PLASTIC ® 90. NONE ❑ 99. OTHER (Specify): 464k1. __...._ FILL COMPONENTS INSTALLED ® 1. SPILL BUCKET ® 3. STRIKER PLATE/BOTTOM PROTECTOR ® 4. CONTAINMENT SUMP 451a -c. VII. UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE ❑ 1. SINGLE WALL ® 2. DOUBLE WALL ❑ 3. NO DISPENSERS ❑ 90. NONE 469a. -' -'---.._....__.-........................................._......_........_.._..__......_........................__....------.......................... _...................................................._--..........................................__..................................................__.............................................. __................................................._............................................. 4696. CONSTRUCTION MATERIAL ❑ I. STEEL ® 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. W DATE 08/13/09 470. APPLICANTIATs_ _ APPLICANT NAME (print) Chevron Products Co./ JIM HARTMAN 471. APPLICANT TITLE Retail HES Permit Desk 472, UPCF UST -B Rev. (12/2007)