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UNIFIED PROGRAM CONSOLIDATED FORM <br /> UNDERGROUNDSTORAGETANK <br /> OPERATING PERMrr APPLICATION-TANK INFORMATION (Onelbirm paTUs') <br /> TYPE OF ACTION III(Check om item only, F-MST=or remplewonly Hats section and Sectfom,I,Il,111,T mrd 17 below) 430. <br /> ❑ L NEW PERMIT 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION <br /> 6,TEMPORARY US'T CLOSURE 7,UST PERWNIINT CLOSURE ON SITE Q 9,UST REMOVAL <br /> DATE UST PERMANENTLY CLOSED. 49x4 T DRfk EXISTING LIST DISCOVERED: 430b. <br /> I. FACILITY INFORMATION <br /> FACILITY ID#(Agemy Um Only) <br /> BUSINESS NAME(Same as h'actf&Name ar DDA-Dotng 1lsohmas As) 3. <br /> Chevron Station#96171 <br /> BUSINESS SITE ADDRESS 1°3• CITY 104• <br /> 6633 Pacific, Ave Stockton,CA 95207 <br /> H. TANK DESCRIMON <br /> TANK ID 9 432. TANK MANUFACTURRR 433, TANK CONFIGURATION:TIUS TANK IS 434, <br /> a I;RX�s ® 1.A STAND-ALONE TANK ConmWe 0M pw for" <br /> ❑ 2.ONE IN A COMPAR7MFNTF13 UNIT anapatuM in the w1h. <br /> DATE LIST SYSTEM INSTALLED 435. TANK ZX_FACr1 Y'1N GALLONS 436. NUMBER OF COMPARTMENTS tN n IE,UNIT 439. <br /> 01/01/1986 10 000 0 <br /> III. TANK USE AND CONTENTS <br /> TANK USE N I a.M(VTnk Vr)ITCLL TIJELING ❑ Ib."INA FUELING ❑ la.AVIATION FUELING 434• <br /> ❑ 3. CAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTk3 U3m aT) ❑ 5.EMERGENCY GENERATOR FUEL PMC 9252913(p)]] <br /> ❑ 6.UTT4ER OHNERATOR FUEL ❑ 95,UNKNOWN ❑ 99,UTHF.tt{spedfl <br /> C.'UNTUNTi'S PETROLEUM: I a.KhOULAR UNLEADED ❑ Ia.MIDORADE UNLEADED ❑ lb.PREMIUM UNI..F.AIM13 440. <br /> ❑ 3.DIESEL ❑ 5-JET FUEL ❑ 6.AVJATION GAS <br /> 8.PETROLEUM BTM FUEL ❑ 9.OrMRPbMOLEUMI 440` <br /> NON PETRULhUM; 7.USED OIL I0.fs71tANOL <br /> t t.OTHER NON.PBTROLEUM 440b. <br /> IV. TANK CONSTRUCTION <br /> TYPE OF TANK ❑ 1.SINGLE WALL IN 2.DOUBLL WALL _D_95.UNKNOWN 443. <br /> PRIMARY CONTAINMENT O 1,STEEL 10 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444• <br /> ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99,OTHER(Specify): 4444• <br /> SECONDARY CONTAINMENT ❑ 1.S=-L 10 3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LDM ❑ 7.JACK 493• <br /> ❑ 90,NOW, ❑ 95.T ❑99,OTHER(S 'f ; 445®. <br /> OVERFILL PREVlvNTION ® I.A1jnm .,k vi%t1A1.AI.ARMS ❑ 2.BALL PLOAT 0 3.DILL TIME SHUT-OFF VALVF. 4s2 <br /> 4.TANK MELTS RUNIREMWn FOR EXIINIPTION FROM OVERFILL PREVWI ION HqAPMENT <br /> V. PRODUCT/WASTE PIPING CONESTRU ON <br /> PIPING CONSTRUCTION ❑ 1.S)N0L£ .. _ �_�.......... . <br /> SYSTFM'TYPE Im 1,I'RL'SSURI © 2.GRAVITY ❑ 3.CnNyENTIONAL SUCTION ❑ 4.SAFE SUCTION In CCR 12676(ax3)) T� r 43E• <br /> PRIMARY CONTAINMENT ❑ 1.ST SEL ® 4.FIBERGLASS ❑ S.FLEMBLE ❑ 10.RIGID PLASTIC: 464. <br /> _ ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER( ify)� n <br /> S);CONDARY CONTAINMENT (3 1.STEEL ® 4.FIBERCrLASS ❑ $.FI FXIFII F ❑ I0.RIGIDPLASTIC 464b. <br /> _ ❑ 90,NONE ❑ 05.014K IOWN ❑ 99.OTITUR(Sp Y): 464x. <br /> ®PIPINGITURBINE CONTAINMENT SUMP TYPE ® 1.SINUI X WALL p2.DOUBLE WALL ❑ 90.NOW 464d <br /> VI. VENT,VAMR RECOVERY )AND RISER/FILL PIPE PIPING CONSTRU ON <br /> VENT PRIMARY CONTAINMENT 0 1.STEEL El 4.FIBERGLASS [:] 1o,RIGID m ASTTC [39o.NONE [3T 99.OHER(specify): j <br /> VENT SECONDARY CONTAINMENT ❑ J.STAT. ❑ 4,FIBERGLASS ❑ 10.R101U PLASTIC ISI (A).NONE A 0 99.OTHER(Specify): 464$6, <br /> VR PRIMARY CONTAINMENT ❑ I.ST60, 0 4.FIBERGLASS ❑ 10,RIGID PLASTIC ❑ 90.NONE_.®_N 99.OTHER(Specify): 4 464&1, <br /> VR SSCONUARY CONT 131.S1'FEL ❑ 4.FIBERGLASS C310.RIGID PLASTIC ® 90.NONIr ❑ 99.OTHER(Specify): <br /> VENC PIPING TRANSITION SUMP TYPE �. ❑ 1.SDI=WALL ❑ 2,DOUBLE WALL. 19 90.NONE <br /> 461 <br /> RISER PRIMARY CONTAINMENT 9 1.sTEra. ❑ 4.FIBERGLASS ❑ 10,RiG1D PLASTIC ❑ 90.NONE d 99.OTHER(Speaify): <br /> 12.15ER SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBRRGLASS ❑ 10.RIGID PLASTIC ® 40.NOM: ❑ 94.OTHER(spedfYfi <br /> FILL COMPONENTS INSTALLED ® 1.SPILL BUCKETM ® 3,%'i'ItIKF.R PLATEIBOTTOM PROTrLTOR 4,CONTAINmrNT SUMP 45tac, <br /> VII. UNDER DISPENSER CONT NT(UDC) <br /> CONSTRUCTION TYPE 10 I.SINGLE WALL E32,1301MI.E WAIS. El 3.NO DISPENSERS ❑ 90.NONE 469& <br /> MCONSTRUCTION MATERIAL �� ,[3 1.STEEL_ 0 4.FIBERGLASS ❑ 10,81010 PLASTIC ❑ 99.0THER(Specify) <br /> VIII. CORROSION PROTECTION <br /> ST'EEI,COMPONENT PROTECTION ❑ 2_SACRIFICIAL ANODL(S 0 4.RAMMED CURRENT ❑ 6.ISOLATION 448. <br /> UL APPLICANT SIGNATURE <br /> CERMCAIION:I cerfhp that this Uff systeut is compadble with tale hamMous substance stomd and that the fill" radon pMVIded hereln 19"ve, <br /> accurate and is fiIH cam isfscc witi ho EMairements. <br /> APPLICANT SIGNATURE:4F .D a+.agrX3MZ DATE 01/12/2009 470. <br /> APPLICANT NAME(phis) C6ema Products ceirRED MARTINIi7. 49f. APPLICANT TITLE Retail YLS Permit Desk 4n. <br /> UPCF UST-13 Rev.(1=007) <br /> ZTO0 v1QfiDY Ot12 af) z9go ZZ9 9Z6 Yva 0:60 6002/ZZ/ZO <br />