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IFIED PROGRAM CONSOLIDATED F UNDGETANK OPERATING PERMIT APPLICATION-TANK NFORMATION(One forth per UST) TYPE OF ACTION (Check one item only. For an UST permanent closure or removal,complete only this section and Sections I,if,III,N,and IX below) 4311 ❑ I.NEW PERMIT ❑ 3.RENEWAL PERMIT ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE [1 5.CHANGE OF INFORMATION DATE UST PERMANENTLY CLOSED: OS ❑ 8.UST REMOVAL DATE EXISTING UST DISCOVERED: 430h I. FACILITY FACILITY ID# INFORMATION(Agency Use Only) BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 4 3 4 3 Valero Corner Store #3698 3 BUSINESS SITE ADDRESS 153 E. I I Street 103 CITY Tracy 1110 TANK ID# 3698-1II.TANK DESCRIPTION 032 TANK MANUFACTURER 433 Modem Welding TANK CONFIGURATION: THIS TANK IS 434 ®I.ASTAND-ALONE TANK ❑2.ONE IN A COMPARTMENTED UNIT. DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 Com lett DaU311sac for each coin arlmem in the unn. 10/01/1987 10,000 NUMBER OF COMPARTMENTS IN THE UNIT 437 TANK usE III.TANK USE AND CONTENTS ® la.MOTOR VEHICLE FUELING ❑ lb.MARINA FUELING ❑ 3.CHEMICAL PRODUCT l: ISTORAGE ❑ q.HAZARDOUS WASTE(IncluJes UseO Oil Ic.AVIATION FUELING q39 ❑ 6.OTHER GENERATOR FUEL 7 ❑ S.EMERGENCY GENERATOR FUEL IHSC g25281.5(c6 CONTENTS PETROLEUM: ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): ® Ia.REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED 439a ❑ 3.DIESEL ❑ 5.JET FUEL ❑ Ib.PREMIUM UNLEADED qqp ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM 6.AVIATION GAS NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL 1111.OTHER NON-PETROLEUM(S cif): TYPE OF TANK IV. TANK CONSTRUCTION 44(16 ❑ I.SINGLE WALL ® 2.DOUBLE WALL PRIMARY CONTAINMENT ® I.STEEL ❑ 95.UNKNOWN ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 443 [1L 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN 09 9.OTHER SECONDARY CONTAINMENT ❑ I.STEEL ❑3.FIBERGLASS (S cif): gg4a ❑ 90.NONE ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445 OVERFILL PREVENTION ❑ 95.UNKNOWN ®99.OTHER(S if): FRP coated steel ® I.AUDIBLE&VISUAL ALARMS 2.BALL FLOAT 445a ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFI L❑L PREVENTION EQUIPMENT BESHUT-OFFVALVE 452. V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ I SINGLE-WALLED DOUBLE-WALLED ❑99 SYSTEM TYPE ®2. .OTHER ® 1.PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION 461) PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 4.SAFE SUCTION(23 CCR§2636(a)(3B 458 ❑ 90.NONE ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 4M SECONDARY CONTAINMENT ❑ 95.UNKNOWN ❑ 99.OTHERS cif): ❑ I.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE 46aa ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(S cify): 10.RIGID PLASTIC 8646 PIPING/TURBINE CONTAWMEN75UMP TYPE ® LSWGLE WALL 4(4c VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION 4J 11 90 NONE 46 VENT PRIMARY CONTAINMENT ❑ I.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 46ge VENT SECONDARY CONTAINMENT 11L STEEL ❑ 4.FIBERGLASS 1310.RIGID PLASTIC ® 90.NONE El 99.OTHER(Specify) 4y qI VR PRIMARY CONTAINMENT 11L STEEL ® 4.FIBERGLASS 1310.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464g VR SECONDARY CONTAINMENT 13L STEEL ❑ 4.FIBERGLASS 464 1 ❑ 10.RIGID PLASTIC ® 90.NONE 1199.OTHER(Specify) VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL 464h146411 RISER PRIMARY CONTAINMENT ® L STEEL 2.DOUBLE WALL ® 90.NONE ❑ 4.FIBERGLASS d64i ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHERS 46,11 RISER SECONDARY CONTAINMENT OTHER(Specify) 46gj ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 4641 FILL COMPONENTS INSTALLED ® I.SPILL BUCKET 11113.STRIKER PLATE/BOTTOM PROTECTOR ® 4.CONTAINMENT SUMP a464 Smk.I VII.UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ® I.SINGLE WALL CONSTRUCTION MATERIAL ❑ 2.DOUBLE WALL CI 3.NO DISPENSERS ❑ 90.NONE 4694 ® I.STH81. ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Spec if) _ 469hc VIII. CORROSION PROTECTION S"PEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ® 6.ISOLATION 3 +r... 448. IX. APPLICANT SIGNATURE CERTIFICATION: I certify[hat this UST system is compatible with the hazardous substance stored and that the information provided herein t iie$accurate, and in full compliance wit al re uirements. APPLICANT SIGNATURE /Y/ / DATE , 3-7 ' a7n. APPLICANT NAME(print) Sandy Huff Wt/` On' APPLICANTT FLE Compliance Coordinator an. UPCF UST-B-1/1 Rev.(12/2007)