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L.. IED PROGRAM CONSOLIDATEDO C �q UNDERGROUND STORAGE TANK ' 7 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,A III,IV,and LYbelow) 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: 430•. DATE EXISTING UST DISCOVERED: 4301. I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) _ BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3_ Chevron Station#98264 BUSINESS SITE ADDRESS 103 1 CITY 104. 3775 Tracy Blvd Tracy, CA 95304 II. TANK DESCRIPTION TANK ID# �jls 432_ TANK MANUFACTURER 433- TANK CONFIGURATION:THIS TANK IS 434. 2 r#i4,PSP6-7,n5XER•ES ® 1.A STAND-ALONE TANK Complete on,pass for esch ❑ 2.ONE IN A COMPARTMENTED UNIT mmpartmem in she anis. DATE UST SYSTEM INSTALLED 435. TANK CAPACITY IN GALLONS 436_ NUMBER OF COMPARTMENTS M THE UNIT 43z 4"14496 1'i`t�q�7 12,000 0 III. TANK USE AND CONTENTS TANK USE ® Ia.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ In.AVIATION FUELING 439. ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil ❑ 5.EMERGENCY GENERATOR FUEL(HSC§25281.Sir)] ❑ 6 OTHER GENERATOR FUEL ❑ 95 UNKNOWN ❑ 99.OTHER(Specify): 439x. 1110_ _............... _ CONTENTS PETROLEUM: ......... ..._.._....__ ........ _. _........ ❑ Ia.REGULAR UNLEADED ® Ic MIDGRADE UNLEADED E It.PREMIUM UNLEADED 440�- ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS _. __ __ ❑ S.PETROLEUM BLEND FUEL ❑ 9 OTHER PETROLEUMSSEecsfy)_ 440a. NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL _ ❑ IL OTHER NON-PETROLEUM(Specify): IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SrNGLE WALL ® 2.DOUBLE WALL ❑ 95.UNKNOWN 443. ---_-. -STT. ._. 1111....... 0000__0000_ _ PRIMARY CONTAINMENT ❑ 1.STEEL ® 3 FIBERGLASS ❑ 6.INTERNAL BLADDER 444_ ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): - 444•. --_ ________- 0000___ SECONDARY CONTAINMENT ❑ 1 STEEL ®3 FIBERGLASS ❑ 6.EXTERIOR MEkIDRANE LINER ❑ 7.JACKETED Gas. ❑ 90.NONE ❑ 95.UNKNOWN E]99.OTHER(Specify)_ ansa 1111... ......... ................ ............... 1111 __ - OVERFILLPREVENTION ® 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 M 2.DOUBLE WALL ❑ 99.OTHER 460. -SYSTEM__ 1 000_.000- _._ .................. ...._..... 0F0-0i ........ .X3)I.........._"45-8.1 TYPE_ ® 1.PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SOCTION ❑ 4.SAFE SUCTION[23 CCR 42636(ax3)] 55d. PRIMARY CONTAINMENT ❑ 1.STEEL 9 4.FIBERG-DM Li 8.FLEXIBLE_ _________ 10 R __❑ IGID PLASTIC - ---- -_____464__ ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464•. _. ....___._._ ___ NMER STEEL1001 1000_-.. 1101... 0000--4646_. SECONDARY CONTAINMENT ❑ 1 STEEL ® 4 FIBERGLASS ❑ 8.FLEXIBLE ❑ lo.RIGID PLASTIC ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c. .. 1111._.-_ . ......__ ..._._.._ ._1110.. """................ 5055. 4501__ PIPINGl1'URBINE CONTAINMENT SUMP TYPE ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 465l. VI. VENT,VAPOR RECOVERY(VR) AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ® 1.STEEL El 4.FIBERGLASS El 10 RIGID PLASTIC [I90.NONE [1P 99.OTHER(Specify): 464e. 464e1. ............. 0000-_ _. -- ._._____. __----------- 1011... VENT SECONDARY CONTAINMENT ❑ I.STEEL El FIBERGLASS El 10 RIGID PLASTIC ® 9R NONE [199.OTHER(Specify). 464f 464n VR PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90 NONE ❑ 99.OTHER(Specify): 46448 ......... ............... ..1111.... 8........ VR SECONDARY CONTAINMENT ❑ I.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 466hh. 1....1...11... .......1111 1500 ._______ - VENT PIPING TRANSITION SUMP TYPE ❑ 1 SINGLE WALL [12.DOUBLE WALL ® 90.NONE 464' _._._ ................ ............. 1011.. _..._______ -.-_ _-------0- ----------__ .._.._..._. ------ ---............. ......... RISER PRIMARY CONTAINMENT ® L STEEL El 4.FIBERGLASS El 10 RIGID PLASTIC [190.NONE [199.OTHER(Specify): 464°1 5550_ .......... ............. ...............1.111 .__...... 11.11.. ............00.1.. ......................... ......... .......... .1.......... RISER SECONDARY CONTAINMENT ❑ 1.STEEL EI 4.FIBERGLASS [110.RIGID PLASTIC ® 90.NONE CI 99.OTHER(Specify): 44664k. 5050-- -11.1.11-1-1-1-1.111111.. ......... ................. 11...1..1..... ............. ...... . ............._.. _ FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET ® 3 STRIKER PLATEBOTTOM PROTECTOR ® 4.CONTAINMENT SUMP 451°c. VII. UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ® 1.SINGLE WALL [12.DOUBLE WALL ❑ 3.NO DISPENSERS [190.NONE 469• 0100.. ... CONSTRUCTION MATERIAL ❑ L STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) an9o' VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4-IMPRESSED CURRENT ❑ 6.ISOLATION IX APPLICANT APPLICANT SIGNATURE CERTIFICATION: I certify that this UST system is compatible with the hazardous substance stored and that the information provided he "L"rue, accurate,and in full compliance with legal requirements. APPLICANT SIGNATURE:FWd)5ti�9WjVEZ DATE 01/14/2009 V n70. APPLICANT NAME(print) Chevron Products Co./FRED MARTINEZ 47' APPLICANT TITLE Retail HES Permit Desk 472 UPCF UST-B Rev.(12/2007)