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UNIFIED PROGRAM CONSOLIDATED FORM <br /> UNDERGROUNDSTORAGETANK <br /> OPERATING PERMIT APPLICATION-TANK INFORMATION (One form per UST) <br /> TYPE OF ACTION (Check we item only. Fora UST closure or removal,complele only this section and Seclions 1.A Ill.IV;and IX below) Q9. <br /> ❑ I.NEW PERM["f [13.RENEWAL PERMIT ® 5.CHANGE OF INFORMATION <br /> 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ S.UST REMOVAL , <br /> DATE UST PERMANENTLY CLOSED: 4JOe DATE EXISTING UST DISCOVERED: <br /> Xb <br /> I. FACILITY INFORM TION <br /> FAC']LfTY IDk(Agency Use Only) - - I <br /> BUSINESS NAME:(Some as Focihry Nome or DBA -Oning Business.4s) <br /> GI Trucking dba Estes West <br /> BUSINESS SITE ADDRESS 103 CITY iw <br /> 7611 S. Ai rt Way Stockton <br /> II. TANK DESCRIPTION <br /> TAN IDN 11 1 TANK MA UFACTs;71 JrXURE& +al TANK CONFIGURATION:THIS TANK IS 4H- <br /> CaS ® I.A STANDALONE TANK Complmeanp9 f b <br /> 171 LONE IN A COMPARTMENTED UNIT a We n in ibe uwi <br /> ATE USI SYSTEM INSTALLED 113 1 TANKIcANPAUTY IN GALLONS ... I NUMBER OF COMPARTMENTS IN THE UNIT 41' <br /> May 1999 12,000 0 <br /> III. TANK USE AND CONTENTS <br /> TANK USE ® Is,MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ I..AVIATION FUELING 09' <br /> ❑ 3.CHEMICAL PRODUCT STORAGE E34.HAZARDOUS WASTE(IncWda Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL IRSC 4Z6'JLR.11 <br /> [1_ 6.OTHER GENERATOR FUEL_EL ❑ 95.UNKNOWN _ _ ❑ 99.OTHER(Specify) 43% <br /> _ . <br /> _ __ <br /> CONTENTS PHT'ROLEUM: ❑ la.REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ❑ ib.PREMIUM UNLEADED <br /> ® 3.DIESEL ❑ S.JET FUEL ❑ 6.AVIATION GAS <br /> ❑ N [1_ S.PETROLEUM BLEND EL 9.OTHER PETROLEUM(specify) <br /> ___ : 410i <br /> NON TR <br /> -PEOLEUM:['j 7.USED OIL ZY 10 ETHANOL <br /> ❑ 11 OTHER NON-PETROLEUM i ) 4046' <br /> IV. TANK CONSTRUCTION <br /> TYPEOFTANK_ ❑ 1.SINGLE WALL ® 2.DOUBLE WALL 095.UNKNOWN__ �3. <br /> PRIMARY CONTAINMENT IFS L STEEL _❑ 3.FIBERGLASS ❑ 6 L BL.INTERNAADDER a0' <br /> _ _❑ 7.STEEL.INTERNAL LINING._ ❑ 95 UNKNOWN ❑ 99.OTHER(Sp-Aj 900i <br /> SECONDARY CONTAI_NMENT ❑ I.STEEL ®i.FIBERGLASS ❑ 6 EXTERIOR MEMBRANE LINER ❑ 7.JACKETED as <br /> _ ❑_ 90.NONE ❑ 95.UNKNOWN _�W OTHER(Specify). Msa <br /> OVERFILL__PREVENTION ❑ LAUOIBLGR VISUAL ALARMS ❑ 2.BALL FLOAT ® 3.FILL TUBE SHUT-OFF VALVE asi. <br /> d.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT <br /> V. PRODUCT/WASTE PIPING CONSTRUCTION <br /> PIPING CONSTRUCTION ❑ I.SINGLE WALL 02_DOUBLE WALL _099.OTHER 0b0' <br /> SYSTEM TYPE __® LPRESSURE O 2.GRAVITY O 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTIONJzr CCR s16l4l�KJ���_ <br /> PRIMARY CONTAINMENT ❑ L STEEL ® 4 FIBERGLASS ❑ S.FLEXIBLE ❑ 10.RIGID PLASTIC <br /> ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 4641 <br /> SECONDARY CONTAINMENT ❑ L STEEL ® d.FIBERGLASS ❑ S.FLEXIBLE ❑ 10.RIGID PLASTIC 4446_ <br /> ❑ 90.NONE __❑ 95.UNKNOWN ❑ 99.OTHER(Specify): _ <br /> PIPING/TURBINE CONTAINMENT SUMP TYPE I SINGLE WALL IS 2.DOUBLE WALL [190.NONE 1644 <br /> VI. VENT,VAPOR RECO (VR)AND RISER/FILL PIPE PIPING CONSTRUCTION <br /> VENT PRIMARY CONTAINMENT ❑ L STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC X 90.NONE ❑ 99.OTHER(Specify): 46ae <br /> 461e1. <br /> VENTSECONDARYCONTAINMENT ❑ I STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC $90.NONE ❑ 99.OTHER(specify): aa�i[i <br /> VR PRIMARY CONTAINMENT ❑ I.STEEL 0 4.FIBERGLASS ❑ 10.RIGID PLASTIC Ia 90.NONE ❑ 99.OTHER(Specify): 464n_ <br /> _._._._.___..__...,..___... 4646. <br /> VR SECONDARY CONTAINMENT ❑ I.STEEL 0 4.FIBERGLASS ❑ 10.RIGID PLASTIC Ia'90.NONE ❑ 99 OTHER(Specify): 46461_ <br /> VEN r PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ® 2.DOUBLE WALL .@ 90.NONE <br /> RISER PRIMARY CONTAINMENT I.STEEL 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90 NONE ❑ 99.OTHER(Specify): abs j <br /> RISER SECONDARY CONTAINMENT ❑ I STEEL 0 4.FIBERGLASS ❑ 10.RIGID PLASTIC90 NONE ❑ 99 OTHER(Spemfy): <br /> __ 46461. <br /> ...__._. .___-.. _......_ ..__..__116- -E <br /> ....__._ _ ____.. -._....._-.._..-_-___ IA�c <br /> FILLCOMPONENTS INSTALLED ® I SPILL BUCKET I.STRIKERPLATE/BOTTOM PRO TECTOR ❑ 4.CONTAINMENT SUMP <br /> VII. UNDER DI ENSER CONTAINMENT(UDC) <br /> CONSTRUCTION TYPE ® L SINGLE WALL ❑ 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 469a <br /> CONSTRUCTION MATERIAL L STEEL 0 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) �sZ.4j 4ym. <br /> VIII. CORROSION PROTECTION <br /> STEEL COMPONENT PROTECFION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION 446. <br /> IX. APPLICANT SIGNATURE <br /> CERTIFICATION: 1 certify that this syst 's c le with the haaardom substance stored and that the inform [on provided herein is true, <br /> accurate.and' I alr uiremenn. <br /> APPLICANT SIGNATURE DATE _ z- Ora <br /> i <br /> APPLICANTNAME t) ZG °rl- 0,5 <br /> APPLICANT TITLE N 4n <br /> PPCF US r-R Rev.(12/20117)-1f2 www.unidnr4.are <br />