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ok Dki L. FIED PROGRAM CONSOLIDATED FO UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION (One form per UST) TYPE OF ACTION (Check me 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 ❑ &UST REMOVAL DATE UST PERMANENTLY CLOSED: 430a I DATE EXISTING UST DISCOVERED: 430b. I. FACILITY INFORMATION FACILITY m 4(Agency Use Only) _ I BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3. Chevron Station#98264 BUSINESS SITE ADDRESS 103. CITY 104. 3775 Tracy Blvd Tracy, CA 95304 II. TANK DESCRIPTION TANK ID# 432. TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434_ 3 Tr,4a6 -5 26k XERXES. ® L A STAND-ALONE TANK Complete one page Por each /?K7/0 ❑ 2.ONE IN A COMPARTMENTED UNIT wmpercmens in the u ut. DATE UST SYSTEM INSTALLED 435. TANK CAPACITY M GALLONS 436- NUMBER OF COMPARTMENTS IN THE UNIT 437_ FGF996 {•15 12,000 0 III. TANK USE AND CONTENTS TANK USE ® Is.MOTOR VEHICLE FUELING ❑ lb.MARINA FUELING ❑ In.AVIATION FUELING 439. ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL HISC§25281.5(c)] 0_6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN _ _ 0_99.OTHER(Specify): 439.. CONTENTS PETROLEUM: ❑ I a.REGULAR UNLEADED ❑ 1c.MIDGRADE UNLEADED ® Ib.PREMIUM UNLEADED dan. ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9 OTHER PETROLEUM(Speedy): "On, NON PETROLEUM (] 7.USED OIL ❑ l0.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 449b. 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): 44a. SECONDARY CONTAINMENT [1 L STEEL ®3 FIBERGLASS ❑ 6.EXTERIOR MEMBRANELINER ❑ 7.JACKETED 445_ ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specify): 445.. 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 ❑ L SINGLE WALL ® 2.DOUBLE WALL ❑ 99.OTHER 460 ............ ............... ...... .......... .-....-.-... ......... ......... .. .-.-....-.-. -1-----. ..-.-... _........ _SYSTEM TYPE _® L PRESSURE ❑ 2 GRAVITY ❑_3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[2.3 CCR§2g36(ax3)] 458. PRIMARY CONTAINMENT ❑ I.STEEL ® 4 FIBERGLASS ❑ 8.FLEXIBLE - --- ❑ 10.RIGID PLASTIC ----- ---------464. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify):-------------- SECONDARY CONTAINMENT ❑ 1 STEEL N 4.FIBERGLASS ❑ &FLEXIBLE ❑ 10.RIGID PLASTIC 46ab. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464a PIPINGlrURBINE CONTAINMENT SUMP TYPE ® I SINGLE WALL El2.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): 4Me' -__ ...__- ....... . _.-...... -.-.-.- 464e1._ VENT SECONDARY CONTAINIs4ENT ❑ L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 464fl, .............__ -- _._. _.______.. _.____-___ _ - ...-.-. ......... _464 VR PRIMARY CONTAINMENT ❑ I STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90 NONE ❑ 99.OTHER(Specify): 464 e VR SECONDARY CONTAINMENT EI 1.STEEL EI4 FIBERGLASS [I10.RIGIDPLASTIC ® 90.NONE ❑ 99.OTHER21 4641' (Specify): 464--1. VENT PIPING TRANSITION SUMP TYPE ❑ l SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE 4M` RISER PRIMARY CONTAINMENT ® 1 STEEL ❑ 4.FIBERGLASS ❑ ]0.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): RISER-S-E--C--O--N--D--A--R--Y--C--ON-T--AIN MENT ❑ L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 46,lkl --------- ......... ............ _ _ .._. ___-._.-.-.-._ ........................... ........ FILL COMPONENTS INSTALLED ® 1 SPILL BUCKET ® 3 STRIKER PLATE/BOTTOM PROTECTOR ® 4.CONTAINMENT SUMP 45la-c� VII. UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ® I.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469.. CONSTRUCTION MATERIAL ❑ I STEEL ® 4 FIBERGLASS ❑ 10 RIGIDPLASTIC ❑ 99 OTHER(Specify) nsvb'., VIIL CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION - 448 IX. APPLICANT SIGNATURE CERTIFICATION: I certify that this LIST system is compatible with the hazardous substance stored and that the information provided herein is true, accurate,and in full compliance with legal requirements. APPLICANT SIGNATURE:'F4arD MAR777VEZ DATE 01/14/2009 40 APPLICANT NAME(print) Chevron Products Co./FRED MARTINEZ 471_ APPLICANT TITLE Befall LIES Permit Deskb _ 472 t<. UPCF UST-B Rev.(12/2007)