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Dec 12 08 03:46p John Johnson 916-443-6225 p.5 UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION(011e fmm yer US't) OF ACTION (Check one item only. For UST pefmaaetr[closure or n nlovai,contple only this soc000 aM Sectioos I,II,IH,N,and DC below). 410 1.NEW PERMIT it 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.USPPERMANENT CLOSURE ON SITE S.UST REMOVAL DATE USI'PERMANENTLY CLOSED,. DATE EXISTING UST DISCOVERED,. 4305 I. FACILITY INFORMATION FACILITY ID 9(Aw xy Use OWy) l BUSINESS NAME(Same as FACJLD'Y NAME orrDBA-Doing Busimss As) 1 BUSINESS SITE ADDRESS 1m CITY iw It.TANK DESCRIPTION - - TANK IDa 432 / `rTAfNKMANUFACTURRE1ER 4D TANKCDWGURLBS AnGN'TTANKQ 434 5 { LCSr�MeAL ❑ILA STAND-ALONE TANK (fe Q ONERJACGMPA0.iMENTPD UMI'. LaN ocom fvevh aNneitin nevi DATE2J SYSTEM STALLED 445 TANK CAPACITY IN GALLONS as NUMBER OF COMPARTMENTS IN THE UNIT 437 4illI.TANK USE AND CONTENTS TANKUSE Ia.MDTOR VEMREPUEI.ING ❑ lb.MARINA PURLING ❑ 1..AVIAnON FUELING 439 ❑ 3.CHEMICAL PRODUCE STORAGE ❑ 4.HAZARDOUS WASTEtIv3WO Q]) ❑ 5.EMERGENCY GENERATOR FUEL p=Fa631.6(Ol ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER 'w: u9s CONTENTS PETROLEUM: ❑ 1.REGULARUNLEADED ❑ Ic.MIDGAADEUNLFADED ❑ Ib.PREMNM UNLEADED 4b �.DIESEL ❑ S.JET FUEL ❑ 6.AVIATION GAS ❑ e_PETROLEUM BLEND FUR. ❑ P.OTHER PETROLEUM S Np NON-PETROLEUM:❑ 7.USED OIL ❑ 10.EIHANOL ❑ ILOTHF.RNON-PETROLEUM Nob IV. TANK CONSTRUCTION TYPE OF TANK I.SINGLEWALL IC.55NFE WALL 95.UNKNOWN N3 PRIMARYOONTAINMENT ❑ I.STEEL 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 44s ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER ( aeq SECONDARY CONTAINMENT ❑ 1.STEEL FIBERG . LASS . ❑ 6.EXTERIOR MEMBRANE LINER ❑ ].JACKETED 445 ❑ .NONE ❑ 95.UNKNOWN 99.OTHER(Sp eci : 44fa OVERFILLPREVENTION LAUD®LE&VLSUAL ALARMS iHALL PLOAT 3.FILL TUBE SHUT-OFF VALVE 451 ❑ 4.TANK MEETS REQUJREMENTSORE)MMPn(3NFROMOVERFILLPREVEKMNEQUIPMENT V. PRO UCT!WASTE PIPING CONSTRUCTION - PIPMGCUNSTfiUCIION ❑ .SINGLE-WALLED 2.DOUBLCWALLED 99.GTFMR q6p SYSTEM TYPE LPRESSURE LGRAVfiY ❑3.CONVENTIONAL SUCTION ❑ 4.SAFE 6(w)) 4M PRIMARY CONTAINMENT ❑ I.STEEL {.FIBERGLASS ❑ e.FLEXIBLElo_RIGID PLASEJ[ 454 ❑ 90.NGNE -❑ 95.UNKNOWN ❑ 99.OIHER(Spe91(yx 4Ne SECONDARY CONTAINMENT ❑ 1.STEEL 4.FIBERGLASS ❑ 6.FLEXIBLE 10.RIGID PLASTIC 4666 ❑90.NONE ❑ 95.UNRNOWN ❑ 99.07NER(Spccly): 464 PIPING/TURBINE CONTAINMENT SUMP TYPE. ❑ I.SINGLE WALL A 2.DOUBLE WALL El 9o.NONE Nod VI.VENT,VAPOR RECOVERY-(VR).AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT 0 LSTEEL 4.FIBERGLASS El I0.RIGfDPUSTIC 90.NONE ❑ 99.GTHER(Specify) 464 4Nc1 VENT SECONDARY CONTAINMENT 0 1.STEEL, 4.FIBERGLASS 0 10.RIGID PLASTIC 90.NONE 99.077JER(Speafy) 4mr 4Nn VR PRIMARY ODMAIMg6Hi 1-STEEL 9.FIBERGLASS 10.RIGID PLASTIC 0 90.NONE 99.OTHER(Spedfy) 464g 4Md VRSECONDARYCONTAINMENT Li I.STEEL 4.FIRERGLASS 0 IO.RIGfDPLASrIC 0 90.NONE 0 99.OTHER(Spttify) 464h VENT PfPA'GIM 'IHANSITgN SUMP TYPE I.SINGLE ALL 2.000BLE 4Mhl WAIL 90.NGNE 4641, WSERPRARYCONTAINMENT I.STEEL CFIBERGL.ASS 10.RIGI1 PLISDC 90.NONE u 99.OTHER(Spec(fy) 4641 N'I RISER SECONDARY CONTALNPRENT I. STEEL 4.FIBERGLASS 10.RIGID PLASTIC ❑ 90.NONE 99.OTHER[Specify) aNk b kl FTfL COMPONENTS]NSTALLIID I.SPILL BUCKCI 3.STRIKER PLATEJROTTOM PROTECTOR 4.CONTAINMENT SUMP else VU-UNDF9 DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ❑ FIBERGLASS L SINGLE W 2.DOUBLE WALL CONSTRUCTION MATERIAL ❑ LSTEEL ALL 4. ❑ 3.NODISPENSERS ❑ 90.N014E 4694 ❑ 10.RlGIDI'l.ASTIC ❑ 99.OTFTER(Sped 4®ss -VDI. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE{S) ❑ 4.MPRFSSED CURRENT ❑6ASOLATION N0. -LY. APPLICANT SIGNATURE CRRTMCATION: I terU(y that this UST system n oompatlble wBh the ha rdoua substancesurfed Rad tImI dle ioUrmatlon PnYfded YerNo b trm,arearate, &Wl&fRHmKlPHAWMwlHl almquimmeaM APPLICANT SIGNATURE DATE /2• 4a APPLICANT NAME(pnm) ( n 4J1' APPLICANT TIRE 4n pal fJ!! • �, UPGF USC-B-12 Rev.(]22807)