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IED PROGRAM CONSOLIDATED F06_0' 3 D B q UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION cone fom per UST) TYPE OF ACTION (Check one item only. For a UST closure or removal,complete only this section and Sections I,l!,/I/,/V,and lX 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 Now or DBA-Doing Business As) 3. Chevron Station# 98264 BUSINESS SITE ADDRESS 103. CITY leq 3775 Tracy Blvd Tracy, CA 95304 IL TANK DESCRIPTION TANK ID# YM O5-D5 ^Q432. TANK MANUFACTURER 433 TANK CONFIGURATION:THIS TANK IS 434 R �'! XERXES ® 1.A STAND-ALONE TANK Complete one w8=for each ❑ 2.ONE INA COMPARTMENTED UNIT rampartme rt in the unit. DATE UST SYSTEM MST ,�y,LED /35. TANK CAPACITY IN GALLONS 436, NUMBER OF COMPARTMENTS IN THE UNIT 437 91lli+F+�b II 1;.1k5 12,000 0 III. TANK USE AND CONTENTS TANK USE ® la.MOTOR VEHICLE FUELING ❑ lb.MARINA FUELING ❑ lc AVIATION FUELING 434. ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§25281.5(c)1 ❑ 6.OTHER GENERATOR FUEL _ ❑ 95 UNKNOWN ❑ 99 OTHER(Specify): 439.. CONTENTS PETROLEUM: ® Ia.REUL GAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ❑ 16 PREMIUM UNLEADED 440- ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8 PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM(Specify):, 440.. NON-PETROLEUM 7❑ USED OII. ❑ 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.INTERNALBLADDER --__---_.. -�- 444 . ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): SECONDARY - SECONDA3RY CONTAINMENT ❑ 1.STEEL ® FIBERGLASS [36.EXTERIOR MEMBRANE LINER _❑ 7.7ACKETED 445. ❑ 90.NONE ❑ 95.UNKNOWN _❑99.OTHER(Specify): 445e. 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 ❑ I.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)J_ 458 PRIMARY CONTAINMENT ❑ I.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID-PLASTIC 464&1 _ ❑ 90.NONE ❑ 95.UNKNOWN ❑_99.OTHER(S_pe__c_ify):__ 464. SECONDARY CONTAINMENT ❑ 1.STEEL ® 4 FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 4646. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 4649 PIPING/TIJRBINE 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 ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify). 4�4e1 -----__ ___.._ ____.___ _._-___ _._ .............. .......... _.a8df_. VENT SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4 FIBERGLASS ❑ 10.RIGID PLASTIC ® 90 NONE ❑ 99.OTHER(Specify): 4b4U ........... _.-_...__ ...._.. __..__....... ...__.._ ........... ............. ................_ __--__ .............. VR PRIMARY CONTAINMENT .❑ I STEEL ® 4 FIBERGLASS [110.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): q ge_ VR SECONDARY CONTAINMENT C1 I STEEL ❑ 4 FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): M14(i41 VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE 4M` _.. .............. ............. ...... ..... . ......... ........... .............. .................. _._.. _._.___ ........... ................ RISER PRIMARY CONTAINMENT ® 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): q46 1_ ______. 464k.... RISER SECONDARY CONTAINMENT ❑ 1 STEEL ❑ 4 FIBERGLASS ❑ IO.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 44Mk_ .__.._ ......... .....____ ...._.. ___. __ ...._.... ...................... ................. .. FILL COMPONENTS INSTALLED ® 1 SPILL BUCKET M 3 STRIKER PLATE/BOTTOM PROTECTOR ® 4.CONTAINMENT SUMP 451.-c. VII. UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE ® I.SINGLE WALL ® 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469.. .._....... _.._......... ..........__.... ........ ...1— ...._. __._.. -.. ........ .......... .......... CONSTRUCTION MATERIAL ❑ L STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.01 HER(Specify) 4fi9� VIII. CORROSION PROTECTION 4 ,73 STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION ,r+, 44s IX. APPLICANT SIGNATURE CERTIFICATION: I certify that this LIST system is compatible with the hazardous substance stored and that the information provided SM. tftiff is true, accurate,and in full compliance with legal requirements. APPLICANT SIGNATURE:FXED9KARTjNEZ DATE 01/14/2009 470 APPLICANT NAME(print) Chevron Products Co./FRED MARTINEZ 471. APPLICANT TITLE Retail HES Permit Desk 473 UPCF UST-B Rev.(12/2007)