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AL a 1 (7) 1 IFIED PROGRAM CONSOLIDATED FOR UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION - TANK INFORMATION (One f/2mper"UST) TYPE OF ACTION (Check one item only. For a UST closure or removal, complete only this section and Sections 1, 11, 111, IV, and IX below)430. ® 1. NEW PERMIT ❑ 3. RENEWAL PERMIT El5. CHANGE OF INFORMATION ❑ 6. TEMPORARY UST CLOSURE ❑ 7. UST PERMANENT CLOSURE ON SITE ❑ 8. UST REMOVAL DATE UST PERMANENTLY CLOSED: 430.. 1 DATE EXISTING UST DISCOVERED: 430b. I. FACILITY INFORMATION FACILITY ID # (Agency Use Only) _ _1 ( 7 7 3 BUSINESS NAME (Same as Facility Name or DBA - Doing Business AS) 3. Chevron Station #307709 BUSINESS SITE ADDRESS 103. CITY 104. 10858 Trinity Parkway 1 Stockton, CA 95219 II. TANK DESCRIPTION TANK ID #y�v cf� S 7c5.) 432. TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK IS 434. / 2 XERXES ® 1. A STAND-ALONE TANK Complete one page for each 2. ONE INA COMPARTMENTED UNIT compartment in the unit. DATE UST SYSTEM INSTALLED 435. TANK CAPACITY IN GALLONS 436, ER OF COMPARTMENTS IN THE UNIT 437. 07/01/2007 12,000 2 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 ❑ 99. OTHER (Specify): 439a. -----._._._.._.....-------.._.....__.._...............__......_.......................... -............................ _......._..._..----.._...................................... ................._.................................. _.._.--..__.._.-..._........................ _.....__................................._....... ....... - CONTENTS PETROLEUM: ❑ la. REGULAR UNLEADED ❑ lc. MIDGRADE UNLEADED ® Ib. PREMIUM UNLEADED 440. ❑ 3. DIESEL ❑ 5. JET FUEL ❑ 6. AVIATION GAS BLEND FUEL 0 9. OTHER PETROLEUM (Specify); 440a. .......... _._............. .................--..__..--------_____.._ .._8.:._PETROLEUM ............ _.............................. 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 ❑ I. STEEL ® 3. FIBERGLASS ❑ 6. INTERNAL BLADDER 4� ❑ 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 [199. OTHER (Specify): 445a. OVERFILL PREVENTION ® 1. AUDIBLE & VISUAL ALARMS [12. BALL FLOAT ® 3. FILL TUBE SHUT-OFF VALVE a52. ❑ 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 ® I . 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 464. ❑ 90. NONE ❑ 95. UNKNOWN ❑ 99. OTHER (Specify): 464x. - ._.........__..............................................._.............. --......_......_.._.._.._...._........._....._....._..._....-...__....._.................................................._.... SECONDARY CONTAINMENT ❑ L STEEL ® 4. FIBERGLASS [18. FLEXIBLE El 10. RIGID PLASTIC 464b. ❑ 90. NONE ❑ 95. UNKNOWN ❑ 99. OTHER (Specify): 464c. .............. .... .......... _............... ..................................................._..................................................................................................................................... PIPING/TURBINE CONTAINMENT SUMP TYPE ❑ I. 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 [310. RIGID PLASTIC [190. NONE [199. OTHER (Specify): 464e1. ............................................................. - --- .._.._.._......_.....---.....................--- .......... ... - .......... -----.---......................................................_......._.............._......._...----.................................................................................................................__..... ....464£...... VENT SECONDARY CONTAINMLN 1 ❑ 1. STEEL ® 4. FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 90. NONE ❑ 99. OTHER (Specify): 464£1. VR PRIMARY CONTAINMENT ❑ 1. STEEL ® 4. FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 90_ NONE ❑ 99 OTHER (Specify): 46481_ ------..._- .. _.-......................---------._._..-_.....................-_.._.._..._.............._......_-.._........................-......_... 464h. VR SECONDARY CONTAINMENT ❑ 1. STEEL ® 4. FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 90. NONE ❑ 99. OTHER (Specify): 464h1 .......... .......- --...------................._.._....................-........_..........._...................-._.._.. -.. - __..__........................................................ _ __.....,....... VENT PIPING TRANSITION SUMP TYPE ❑ 1. SINGLE WALL ® 2. DOUBLE WALL El90. NONE ate' ........... ..................................... .... _........... _............ _---- --._._.._......... -.......... _................ ..................... ..................... __.... _..__.................................... _.... _........ ...... --- ....._...... -.._..-_...-.--.------- ------ ------.................... _........... __.... __._................................... .. - --..-...........-._._.......;...... RISER PRIMARY CONTAINMENT ® I. STEEL El.. FIBERGLASS ❑ 10. RIGID PLASTIC [1. NONE ❑ 4643. 99. OTHER (Specify): a64j1, ......................... .................................. ....._.._........... _....... ............................ ..... _.._..................... _..---....................................... ........................................... _..__............... _.......... ........................ ....... ................._..___..__.............---464k. RISER SECONDARY CONTAINMENT ❑ I. STEEL ❑ 4. FIBERGLASS [1]0. RIGID PLASTIC ® 90. NONE [199. OTHER (Specify): 464k1. ...... .......... ............................ -...................... ......-............ __._.................. ....-................. ............................................................. ... _._............................... ..... .... .......................................... ................................................................ _............................... ........................................................................ ...................... FILL COMPONENTS INSTALLED ® I. SPILL BUCKET ® 3. STRIKER PLATE/BOTTOM PROTECTOR ® 4. CONTAINMENT SUMP 45la-c. VII. UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE ❑ 1. SINGLE WALL ® 2. DOUBLE WALL ❑ 3. NO DISPENSERS ❑ 90. NONE 469x. ...........---........................_...................................._.........................._....................................................................................... - ....._.._..-..._............................................................................................... _..._......................................................... _............. . 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. 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. ,N DATE 08/13/09 470. : APPLICANT NAT REo' APPLICANT NAME (print) Chevron Products Cod JIM HARTMAN 471. APPLICANT TITLE Retail HES Permit Desk 472 UPCF UST -B Rev. (12/2007)