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IFIED PROGRAM CONSOLIDATED F UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION One form TYPE NEW ACTION (Check one item only, For an UST permanent closure or removal,complete only this section and Sections I,it,III,N,and IX beloper w) at0 ❑ 1.NEW PERMIT ® 3.RENEWAL PERMIT ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 5.CHANGE OF INFORMATION DATE UST PERMANENTLY CLOSED: 430a ❑ 8.UST REMOVAL DATE EXISTING UST DISCOVERED: 430n FACILITY ID#(Agency Use Only) L FACILITY INFORMATION BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 4 `� 4 3 Valero Corner Store#3698 BUSINESS SITE ADDRESS 153 E.1 I ni Street 103 CITY Tracy 04 TANK ID# 3698-2II.TANK DESCRIPTION 432 TANK MANUFACTURER 433 TANK CONFIGURATION: Modern Welding THIS TANK IS I.A STAND-ALONE TANK 434 DATE UST SYSTEM INSTALLED 415 ❑2.ONE M A COMPARTMENTED UNIT. TANKCAPACITY W GALLONS 436 Com fete one eron each cc anment in the unit. 10/01/1987 10000 NUMBER OF COMPARTMENTS IN THE UNIT 432 TANK USEUELING III.TANK.USE AND CONTENTS ® la.MOTOR VEHICLE FUELING ❑ Ib.MARINA F ❑ 3.CHEMICAL PRODUCT STORAGE [3 4.HAZARDOUSWASTE(Includes 13 Ic.AVIATION FUELING 439 FUEL Used Oil? ❑ 6.OTHER GENERATOR ❑ 5.EMERGENCY GENERATOR FUEL[HSC§25281.5(c)j ® la CONTENTS PETROLEUM: ❑ 95.DNKNOWN ❑ 99.OTHER (Specify).REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ( ce 439a [1 3.DIESEL ❑ 5.JET FUEL in PREMIUM UNLEADED 440 ❑ 8.PETROLEUM BLEND FUEL ❑ 9,OTFBiR THANOL PETROLEUM � 6.AVIATION GAS NON-PETROLEUM:' 7.USED OIL (S ci ): awa ❑ I1.OTHER NON-PETROLEUM(S ❑ 10.Eecif): IV. TANK CONSTRUCTION 44on PRIMAR CON ❑ L SINGLE WALL PRiMARy CONTAINMENT ® 2.DOUBLE WALL ❑ 95.UNKNOWN ® 1.STEEL ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 443 SECONDARYCONTAINMENT 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN 444 ❑ 1.STEEL ❑3.FBERGLASS ❑ 99.OTHER (S if); 4a4a ❑ 90.NONE ❑ 95.UNKNOWN 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED OVERFILL PREVENTION ®99.OTHER(S cif): FRP coated steel 445 ® 1.AUDIBLE&VISUAL ALARMS ❑ 2,BALL FLOAT 445a ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQI USE UIPMENT PIPING 452' V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTR UC TION ❑ I.SINGLE-WALLED ®2,DOUBLG-WALLED SYSTEM TYPE ® I.PRESSURE ❑99.OTHER PRIMARY CONTAINMENT ❑ 2 GRAVITY ❑ 3.CONVENTIONAL SUCTION 460 ❑ 1.STEEL 29 4,FIBERGLASS ❑ 8.FLEXIBLE 4,SAFE SUCTION 123 CCR§2636(a)(3p 458 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.GTHER(S cif): l0.RIGID PLASTIC 464 SECONDARY CONTAINMENT ❑ 1.$TEFL 44 ® 4.FIBERGLASS ❑ g,FLEXIBLE ❑ 10.RIGID PLASTIC Ma ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 4641, PIPING/TURBINE CONTAINMENT SUMP TYPE 461, ® I.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE VI. VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ LSTEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464c VENT SECONDARY CONTAINMENT ❑ LSTEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE 4644 VR PRIMARY CONTAINMENT ❑ 99.OTHER(Specify) 4644 ) 4 ❑ I.STEEL R9 4,FIBERGLASS ❑ 10.RIGID PLASTIC ❑ W.NONE ❑ 99.OTHER(Specify) 464171 464 VR SECONDARY CONTAINMENT ❑ 1.STEEL s ❑ 4.FIBERGLASS ❑ 10,RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify) 44641 VENT PIPING TRANSITION SUMP TYPE ❑ LSM:L WALL M,411 RISER PRIMARY CONTAINMENT ® 1.STEEL ❑ 2.DOUBLE WALL ® 90.NONE 4641 ❑ 4.FIBERGLASS ❑ 10.RIGm PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 4641 RISER SECONDARY CONTAINMENT ❑ I.STEEL ® 4.FIBERGLASS g641 ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 41 FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET ® 3,STRIKER PLATE/BOTTOM PROTECTOR ® 4.CONTAINMENT SUMP JAukc CONSTRUCTIONMTYPE A"fER1AI, VII.UNDER DISPENSER CONTAINMENT(UDC) CONS T"RUCTION ® 1.SINGLE WALL ❑ 2. ^E DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE'' 469a ® L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(S cif) 4691,-c VIII. CORROSION PROTECTION STGBL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ® 6.ISOLATION 448. LICANT CERTIFICATION: Ice [ha[this UST system is comps[IX. le wi[hPthe ha douse substancestored and that the information provided herein-is[rue,accurate, and in full com Bance with le al re uiremen[s. APPLICANT SIGNATURE DATE I a 7 470. APPLICANT NAME(print) Sandy Huff 471. APPLICANT TITLE Compliance Coordinator 472. UPCF UST-B-1/1 Rev.(12/2007)