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UNIFIED PROGRAM CONSOLIDATED FO �1 UNDERGROUND STORAGE TANK Z I j rw,( OPERATING PERMIT APPLICATION-TANK INFO ION(one form per UST) TYPE OF ACTION (Check one item only. For an UST permanent closure or removal,complete only this section and Sections 1,II,III,IV,and IX below) 411' ❑ 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 DATE EXISTING UST DISCOVERED: ai0h I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) TT I BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) Valley Pacific Petroleum-Fresno Ave Cardlock BUSINESS SITE ADDRESS 103 CITY 104 1524 Fresno Ave Stockton II.TANK DESCRIPTION YANK ID# 432 TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK IS 434 Co 1.A STAND-ALONE TANK I Trusco ❑2.ONE IN A COMPARTMENTED UNIT. Complete one page for each com arunent in the unit. DATE UST SYSTEM INSTALLED +35 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 1997 20,000 1 III.TANK USE AND CONTENTS TANK USE C1 la.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ Ic.AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§25281.5(c)) ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 439a CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED ❑ lc.MIDGRADE UNLEADED ❑ Ib.PREMIUM UNLEADED 440 M 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM (Specify): 440a NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL 11.OTHER NON-PETROLEUM(Specify): 4406 IV. TANK CONSTRUCTION TYPE OF TANK ❑ I.SINGLE WALL M 2.DOUBLE WALL ❑ 95.LNKNOWN 443 PRIMARY CONTAINMENT (9 1.STEEL ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 441 ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER cif): 444a SECONDARY CONTAINMENT C11.STEEL [13.FIBERGLASS [16.EXTERIOR MEMBRANE LINER S 7.JACKETED 445 ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specify): 445a 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 ❑1.SINGLE-WALLED M 2.DOUBLE-WALLED ❑99.OTHER SYSTEM TYPE EX 1.PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION 0 4.SAFE SUCTION[23 CCR§2636(aX3)1 4`'' PRIMARY CONTAINMENT ❑ I.STEEL ❑ 4.FIBERGLASS Of 8.FLEXIBLE ❑ 10.RIGID PLASTIC 46 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464a SECONDARY CONTAINMENT ❑ L STEEL ❑ 4.FIBERGLASS 8.FLEXIBLE ❑ 10.RIGID PLASTIC 4646 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c PIPING/TURBINE CONTAINMENT SUMP TYPE IN 1.SINGLE WALL 0 2.DOUBLE WALL ❑ 90.NONE 46+d VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT 1.STEEL IN 4.FIBERGLASS 10.RIGID PLASTIC 90.NONE 99.OTHER(Specify) 464e 464el VENT SECONDARY CONTAINMENT 0 L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC 90.NONE ❑ 99.OTHER(Specify) 464f 461Fl VR PRIMARY CONTAINMENT L STEEL 0 4.FIBERGLASS ❑ 10.RIGID PLASTIC 90.NONE ❑ 99.OTHER(Specify) 4645 4611 VR SECONDARY CONTAINMENT 1.STEEL 0 4.FIBERGLASS ❑ 10.RIGID PLASTIC 90.NONE ❑ 99.OTHER(Specify) 464h 464h1 VENT PIPING TRANSITION SUMP TYPE ❑ I.SINGLE WALL ❑ '.DOUBLE WALL 90.NONE 4641. RISER PRIMARY CONTAINMENT 1.STEEL 4.FIBERGLASS ❑ 10.RIGID PLASTIC 90.NONE E3 99.OTHER(Specify) 464i 464'1 RISER SECONDARY CONTAINMENT ❑ 1.STEEL 4.FIBERGLASS ❑ 10.RIGID PLASTIC 90.NONE 99.OTHER(Specify) 464k 464k1 FILL COMPONENTS INSTALLED M 1.SPILL BUCKET 21 3.STRIKER PLATE/BOTTOM PROTECTOR 4.CONTAINMENT SUMP 45la-c VII.UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE M 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469 CONSTRUCTION MATERIAL Tr-i-s-T-EE-7-73 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) �`>h VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT M 6.ISOLATION s IX. APPLICANT SIGNATURE CERTIFICATION: 1 certify that this UST system is compatible with the hazardous substance stored and that the information provided herein is true,accurate, and in full com Iia a with I requirements. APPLICANT SIGNATURE .-.• DA 11:, 70 7/30/2010 APPLICANT NAME(print) Mike Elinson 471. APPLICANT-TITLE Cardlock Manager „ UPCF UST-B-1/2 Rev.(12/2007)