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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION(One tonin per USI) TYPE OF ACTION (Check one item only. For an UST permanent closure or removal.complete only this section and Sections I,II,III.IV,and IX below) 410 ❑ 1.NEW PERMIT ® 3.RENEWAL PERMIT ❑ 5.CI IANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑x7.UST PERMANENT CLOSURE ON SITL ❑ S.UST REMOVAL DATE UST PERMANENTLY CLOSED: 4'01 I DATE EXISTING UST DISCOVERED: 1'°6 1. FACILITY INFORMATION FACT L.ITY I D K I:Igencp Gse Only) _ - y = BUSINESS NAME(Salutes FACILITY NAME or DBA-Doine Business.As) 3 Miles Trust Property BUSINESS SITE ADDRESS 103 1 CITY Stockton;CA 9.1'06 194 1940 South American Street - IL TANK DESCRIPTION1i U - TANK IDN 432 TANK MANUFACTURER .13I TANI:CONT ICI R\IIfI IIIS TANK Is G_. _.: „l. 1 „ _- ( 134 © LASI'AND-:ALOMI'VAK Unknown ❑2.ONE INA C'ONIP.\III\IENTED UNfr. Com lase oneiu.ce fill cock con o:ummni in,he 1111. DATE UST SYSTEM INSTALLED 431 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPAR LIVIENTS IN THE UNIT 437 Unknown 250-500 ONE 111.TANK USE AND CONTENTS TANK USE Ia.MOTOR VEHICLE:FU FLING ❑ Ib.NIARINA PURLING ❑ I..ANq-%1"I0N FUELING 439 ❑ 3.CI'IENIICAI.PRODUC"I'S"1'OR.\GI? ❑ 4.11:\Z.:\RUOCS\\'.-\S'fE llndudes t's.d Ull ❑ 5E\IERGENC\'CENER.\'I"ORFUELIHSC#2i=31.51.11 ❑ 6,OTHER GENERATOR FUEL ❑ 95.UNKNO\YN ❑ 99.OtHER (Specifv): 4311,, CONTENTS PETROLEUM: EN M.REGULAR UNLEADED ❑ Ic.MIDGRADF UNLE\DED ❑ I6.PREMIUM UNLEADED 440 3.DIESEL ❑ 5.1H'F FUEL ❑ i,-AA'UA ETONGA.S Q a-PETROLEUM BLEND FUEL ❑ 9.01'HERPIFIROLEUM IS xciP'P. 4411' SON-PETROLEUM:❑ 7,USED OIL ❑ III.ETHAN01. ❑ I L ETHER..\'ON-PE"FRfILEUN4(S loll',): 4406 IV. TANK CONSTRUCTION TYPE OF"I"ANN ® I.SINGLEWALL 02.DOUBLEWALL [1 115,UNKNO\\'N 441 PRINIARYCONT.AINNIENI' E I.SITU- ❑ 3.FIRFRGLASS ❑ 6.INI"FR\AL BLADDER 441 ❑ 7,STEEL IA I EKAA1.l.I,A TAG ❑ 95. -NKNMAA ❑ 99.0'I ut (SP'w:k) 444., SECONDARN'CONIAINNIFNE ❑ I.SI"E:EI. ❑3 FI ILRGLASS ❑ 6.F: I-EKIORNIENIBRANELINER ❑ 7 !:ACKEIED 445 ❑ 90-NONL ❑ 'S.I Al (ANN ❑99.0'11 iBl2 lSPcailct 445" OVERFILL PRrVFNIION ❑ I.AI i DI BLE&NIS I I.AL AIt MS ❑ ..BAIL PIDAT ❑ 3.FILL"I I'BF SI It T-OPT VALVE 4\= ❑ 4 TANK NIEEI"S REQI IRLAll'YI A I'(W EXENIPRON FROM ON h:Rl'ILL PREV'I M PION EOUIP.ME.N I V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION 1.SINGLE-WALLED ❑2.DOUBLE-WALLED 099.OTHER 460 SYSTEM TYPE ❑ I.PRESSURE ❑ 2.GRAVITY ❑ ..CONVENTIONAL SUCTION ❑ {SAFF SI CGON 123 CCRF'-636(..111311 456 PRIMARY COMA NIEN'I' © I-S"FEEL ❑ 1.1913FRGLASS ❑ S.FLEXIBLE ❑ 10.1,101DPI.:\S"FIC 464 ❑ 9°.\oml ❑ 115.EFKN'Ow'N ❑ 99.01HERISpi,6ot: 464. SECONDARY CON'I'%INNIE.S I' ❑ I.SEFFI. El.FutF:RGLASS ❑ S.FLEXIBLE ❑ 10.RIGIDPLASTIC 4641, ❑ 90 .MUNE' ❑ 95.UNKNOWN ❑ 99.OTHER(Spccily): 464, PIPINGi TURBINE CONTAINMENT SUMP TYI'll (9 I.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464d VL VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRINI:%RV C"ON I \I:N\IENr B I.STEEL ❑ 4.FIBERGLASS ❑ 10,RIGIDPLASTIC ❑ 90.\'ONC ❑ 99.OTHER(Specil,) 464, 4.,40 VENTSECON'D\R1'CONTAINMENT ❑ I.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PL:AS"rIC E 90.\ONE ❑ 99.OTHER(Spccify) 41,4f 464fl VR PRIM:\RY CONTAINMENT ❑ L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Speci6t 4648 464,1 VR SECONDARY CONTAINMENT ❑ 1,S'FELL ❑ 4.FIBERGLASS ❑ 10RIGIDPLASTIC B 90.NONE_ ❑ 99.OTHER(Speci(v) 46411 464h1 6 ENT PIPING TRANSIT'ION SUNIPTYPE ❑ I.SINGLE WALL 02.DOUBLE WALL Q 90,NONE 4641, RISER PRIMAR\"CONTAINMENT ❑ I.SFFEL [3-4,FIBERGLASS ❑ 10.RIGID PLASTIC IN 90.NONE ❑ 99.OTHER(SpacWl 464, 46411 RISER SECONDARY CONTAINMENT ❑ L STEEL ❑ 4.FIBERGLASS ❑ III.RIGID PLASTIC © 90.NONE ❑ 99.OTHER(Specify) 464% 464%1 FILL COMPONENTS INSTALLED ❑ L SPILL BUCKET ❑ 3.S"FRIKERYLATE/BOITOkI'PROTECIOR ❑ 4.CONTAINNIENTSUNIP 4511-, VII.UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION 1)PE ❑ L SINGLE WALL ❑ 2.DOUBLE WALL ..NO DISPENSERS [9 90.NONE 469,1 CONSTRUCTION MATERIAL ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 4696-c Vlll. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION 446. IX. APPLICANT SIGNATURE CERTIFICATION: 1 certify that this UST system is compatible with the hanvdous substance stored and that the information provided herein is true,accurate, iq and in full coo liance with legal requirements. APNT LTIG DATE 47°. A PLI TNANIE(print) 471 APPLICANTTITLE Toaster 411 Reba Veltri UPCF UST-B-1/2 Rev.(12/2007)