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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUNDSTORAGETANK OPERATING PERMIT APPLICATION-TANK INFORMATION (One fim pa um TYPE OF ACTION (Clerk one INN On1v F-1 a UST eloswe or mmm l cov(ete only this section and Secdons 11/1,Ill 1;aml77below) 430• 1.NEW PERMIT ® 3.RENIiWAI.PERMIT 0 5,CHANGE OF INFORMATION 6,'I-hMPORARY UST CLOSURE Q 7.UST PERMANENT CIASURE ON SITE Q 8,UST REMOVAL DATE(IST P ENT LY CLOSED: 430 DATE EXISTING UST DISCOVERED: 430, L FACILITY INFORMATION FACILITY ID#(Agemy Use Only) - - 1' BUSINESS NAME(Sur es as FacUlry Nam or DBA-Doheg BmhaeJ8 ) s. Chevron Station#96171 BUSINESS SITE ADDRESS 1 CITY 1� 6633 Pacific Avc Stockton, CA 95207 11. TANK DESCRIPTION TANK ID# 452• TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434, I xt✓I��{ES 10 LASTAND-ALONE?•TANK Compleftone pop rtw$to ❑ 2.ONE INA COMPAR'1 UNIT «mgwtw ma in the Ud DATE UST SYSTEM INSTALLED 435. TANK CAPACITY 114 GALLONS 436• NUMBER OF COMPARTMENTS LN'LITE UNIT 437, 01/01/1986 10,000 0 III. TANK USE AND CONTENTS TANK USE N la.M(YIDIt V14HICI.E FUELING ❑ lb.MARINA FUELINO ❑ lc,AVIATION RMIMG 639• ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Ian lied(N!) ❑ 5.ENMGENCY GENERATOR FUEL II1SC 425261.5(c ❑ 6.011IGR OENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OT"F-R(Specify)' CONTENTS PETROLEUM, I@ Ia.RROULAR UNLEADED [3lc.MMGRADL'UNLFADIiD � Q Tb.PREMIUM UNLGADF0 ATO. ❑ 3.DIESEL ❑ 5.JET FUGI, ❑ 6,AVIATLO14 OAS _ ❑ 8.PETROL.UUM t1L LEND FUEL. ❑ 9.OTIJER PETROLE(�S�Ocity): "0m.NON-PETROLEUM; 7,USED OIL C3 I0.ETHANOL 11,OTHER NON PETROLEUM , i : 440b, IV. TANK CONSTRUCTION TYPE OF TANTS, ❑ L SINGLE WALL R 2.DOUBLE WALT. ❑ 95.UNKNOWN 443' PRIMARY CONTAR4MENT C3 I.8mm ® 3.Ff01 R(,L.nS5 J36.INTERNAL SLADUER_ ' 44. _ ❑ 7.STEEL+INTERNAL LIN1140 _❑ 95.UNKNOWN ❑ 99.OTtLFR S�eoify); 444°. SECONDARY CONTAINMENT Ll I.S'l-ELT- - ®3.FIBERULASS El 6. MENDRANE LINER ❑ 7.JACKP.T3in 445. _ r_❑_90,NONE ❑ 95.UNKNOWN ❑ 4456' OVERFILL PREVENTION 10 L AUDIBLE,.VISUAL.ALARMS ❑ 2.BAL L FLOAT' v- ® 3.FILL TUBE SIIUT.Urr VALVE 44z. 4.TANK MEETS FOR CX13M PTION FROM OVERFILL PREVENTIONIRLTIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPINO CONSTRUCTION ❑ 1.SINGLE WALL 0 Z DOUBLE WALT. ❑ e9,OTHER 460. SYSTEM TYPE ® I.PRESSURE L3 2,GRAVI'T'Y ❑ 3.CONVENTIUNAI,.SUCTION ❑ 4.SAFE SUC CION(t CCR 636(a 3 4`'6 P Y CONTAINMENT ❑ 1.STEEL, ® 4.MBUROL ASS ❑ 8.FL1 IBLE ❑ 10.RIGID PI.Ab'1'I( 4"• C390.NONE El 95.UNKNOWN 1.❑ 99.OTHER(SpeeciCy); 46Aa SECONDARY(C-UN TAS ❑ 1.S7'FE1. N 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER PIpmn'URBiNE CONTAINMENT SUMP TYPE ® 1.SINGLE'•WALL ❑ 2,r"JBI.R WALL ❑ 9o.NONE VL VENT,VAPOR RECOVERY )AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ® 1.STM-U, ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 98.(71HER(Specify): 46401, VENT SECONDARY CONTAINMENT ❑ 1.STEEL �❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC 19 90.NONE ❑ 99.OTHER(Specify): VR PRIMARY CONTAINMENT C) 1.STEEL ® 4.FIRF;ROLMN ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify); t6q -VR SF.•CONDARY CONTAINMENT Ny E3 1.STEEL ❑ 4.FIBF,ROLASS _❑ l0.RiGW PLASTIC 10 W NONE' ❑ 99.OTHER(Specify); VENT PIPING TRANSITION SUMP TYPE,..., ❑ 1.SINOI,E WALL ❑ 2.DOUBLE WALL 0 90.NONE 464' RISER PRIMARY CONTAINMENT p- ® 1.817.10, C3 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 9D.NONE ❑ 99.(MER(Specify): RISER SECONDARY CONTAINMENT ❑ Timm m ❑ 4.I'MURGLASS ® i0 yRTG1n PIAV.TIC ® 90.NONIi ❑ 99.OTHER(Specify): 464ki. FILL COMPONENTS INSTALLED 10 I.SPILL BUCKET w,. ® 3,STRIKER PLA'fr7B0170M PROTCCfOR ® 4.CON'1'AINNILN'I'SUMP 4 � VII. UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE _ IS 1,SINLL.Ii WAIL 2.DOUNTF WALL ❑ 3.NODLSFENSERS ❑ 90.ALONE 408. CONSTRUCTION MATHR1AL ❑ 1,STEEL M 4,I'I111i14it.ASS E310.RIGID PLASTIC 0 99.OTHER(Specify) s __.._,........ VIII. CORROSION PROTECTION STEEL,COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION 448. DL APPLICANT SIGNATURIE CERTIFICATION: i certify that this UST system is empatihlc with the hazardous substance stored and that the information provided herein Is true, accura and ill LUN cram liance with W Eguirements, APPLICANT SIGNATURE:T4WD 9NM9 gIAE,Z DATE 01/12/2009 471X APPLICANT NAME(pI01t) Cb Products C oJ1 R1:1)MAK'rtNI.;Z 471, APPLICANT TTTLE Retail HFS Permit Desk 477, UPCF UST-B Rev.(124m) CTOz YNaDV OQ2T aD ZC80 ZZ9 5Z6 YVa TP:60 6002/ZZ/ZO