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o5zo�� 1h UNIFIED PROGRAM CONSOLIDATED FORM ' UNDERGROUND STORAGE TANK I A P - OPERATING PERMIT APPLICATION-TANK INFORMA ION(One form per US 1) TYPE OF ACTION (Check one item only. For an UST permanent closure or removal,complete only this section and Sections 1,11,If I,O(Nd fK heI4,U)JI430 ❑ L NEW PERMIT ® 3.RENEWAL PERMIT ❑ S.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE 177,UST PERMANENT CLOSU Rr ON SI"fE ❑ 8.UST REMOVAL DATE UST PERNIANENTLY CLOSED. 410 DATE EXISTING UST.UISCOVER .r th 1. FACILITY INFORNLATION _, I w FACILITYID#(Agency Llse Onl)) I-'"" 1 BUSINESS NAME(Same as FACILITY NAME or DBA-Danns Business AS) Miles Trust Property - BUSINESSSIITADDRESS lo' CI"fY Ia1 t940 South American Street Stockton,CA 95206 IL TANK DESCRIPTION TANK IDN 43 TANK NIANUFACTURER '-" TANKCONFIOUR NFIONN THIST.ANKIs 434 ® I.+STaND-:\LONE I:NK Unknown El 2.ONE IN A C'ONIP:NRI VENTED UNIT. Cm,'m oneaye For eazh mm xnmF NI' umt. DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS J10 NUMBER OF CONIPAR"rMENTS IN THE UNIT 437 Unknown 250-500 ONE 111.TANK USE AND CONTENTS TANK USE Ia.MOTOR VEHICLE FUELING ❑ Ib.NIARINA FUELING ❑ Ic.AVIATION FUELING 429 ❑ 3.0IEMICALPRODUCTSTORAOE ❑ ❑ 5.E\1ERGENCVCENERATORFUEL[HSP,21281.a<q ❑ 6.0"CHER GENERATOR FUEL - ❑ 95.UNKNOWN ❑ 99,OTHER (Specify): 439, CONTENTS PETROLEUM: @c Ia.REGUI-AR UNLEADED ❑ c.MIDGRADFUNLEADED ❑ Ib.PREMMMUNLEADED 449 U3.DIESEL ❑ 5,JET FUEL ❑ 6.AVIATION GAS EIA PETROLEUM BLC-ND FUEL ❑ 9.0"F(IER PETROLEUM (S c6f'): 440, NON-PETROLEUM:❑ 7,USED OIL ❑ '10.ETHANOL ❑-II.OTHER NON-PETROLEUMS eciF): 4106 IV. TANK CONSTRUCTION TYPE OFANK ® I.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 95.UNKNOWN 443 PRINIARY CONI'A NMEN"I ❑ I.STEEL ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444 ❑ 7.STEEL-IN"f ERNAL LINING ❑ 95.UNKNOWN ❑ 99.01 HER (Spccif-): 444, SECONDARY CONTAINMENT ❑ I.STEEL ❑3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445 ❑ 90.,NONE ❑ 95.UNKNOWN ❑99.OTFIER S reci'): 445n OVERFILL PREVENT"ION ❑ I.AUDIBLE&VISUAL.ALARMS ❑ B:\LI.FIDAT ❑ 3.FILLTI-'BE SHUT-OFF VALVE 452. ❑ 4.TANKMEETS REQUIREMENTS FOR ESEMPNON FROMOVERFILLPREVENTIONEOUIP\IENI' V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION - - I.SINGLEAI ALLED EJ 2.DOUBLE-WALLED El 90.OTHER 460 SYSTEM TYPE ❑ I.PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR¢2636(,,)OL 4?8 PRIMARY CONTAINMENT © I.STEEL ❑ 4.FIBERGLASS ❑ S.FLEXIBLE ❑ 10.RIGID PLASTIC 464 ❑ 90''NONE. ❑ 95.UNKNOWN ❑ 99.01'HER(Speaify): 464u SECON'D,\RN CONTAINMENT ❑ I.STEEL ❑ 4.FIBERGLASS ❑ S.FLEXIBLE ❑ 10.RIGID PI 1STIC 4i4b ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(9psify): 464= PIPINOTURBIN1.CONTAINMENT SUMP TYPE 1.SINGLE WALL ❑ 2.DOUBLE\4ALL ❑ 90.NONE 4646 VI.VENT,VAPORRECOVERY (VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRINIARI"CONTAINMENT I.STEEL ❑ 4.FIBERGLASS LI10.RIGID PLASTIC ❑ 90.NONE EI 99.OTHER(Specify) i64e 464e1 VENT SECONDAR'i CONTAINMENT ❑ L STEEL. ❑ 4.FIBERGLASS ❑ 10,RIGID PLASTIC El 90cNONE ❑ 99,OTHER(Specil') 4641' 464f1 VR PRIMARY CONTAINMENT ❑ LSTEEL LJ 4.FIBERGLASS ❑ 10 RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify) 464, 464,1 VR SECONDARY CONTAINMENT ❑ L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC 90.NONE ❑ 99.OTHER(Specifv) 464h 4W61 VENT PIPI';JG TRANSITION SUMP TYPE LJ 1.SINGLE K`ALL El 2.DOUBLE WALL 90.NONE 4641. RISER PFj\IARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC E 90.NONE ❑ 99.OTHER ISPMN) 464, 46411 RISER SECONDARY CONTAINMENT ❑ I.STEEL ❑ 4.FIBERGLASS ❑ In R1GIDPLASTIC © 90.NONE ❑ 99.OTHER(SN61`0 464k 464k1 FILL COMPONENTS INSTALLED ❑ I.SPILL BUCKET ❑ 3-.STRIKER PLATE%BOTTOM PROTECTOR ❑ 4.CONTAINMENT SUMP 45h-c VIT.UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ❑ I.SINGLE WALL ❑ 2.DOUBLE WALL EX 3.NO DISPENSERS ❑ 90.NONE 469, CONSTRUCTION MATERIAL ❑ I.STEEL ❑ 4.FIBERGLASS El 10.RIGID PLASTIC El 99.OTHER(Specify) 4696-� VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION 448. IX. APPLICANT SIGNATURE CERTIFICATION: I certifv'that this UST system is compatible with the hamrdous substance Stored and that the information provided herein is true,accurate, and in full compliance with legal requirements. APNT IG DATE LTa7°_ APLI T NAME(print) 4n. APPLICANT TITLE Trustee 472. Reba VeIVi UPCF UST-13-12 Rev.(12/2007)