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IFIED PROGRAM CONSOLIDATED FW UNDERGROUNDSTORAGETANK OPERATING PERMIT APPLICATION-TANK INFORMATION(one form per UST) _ TYPE OF ACTION (Check one item only. For an UST permanent closure or removal,complete only thissection and Sections I,B,III,IV,and IX below) 430 ❑ 1.NEW PERMIT E 3.RENEWAL PERMIT Sal 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL 4`3DATE EXISTING UST DISCOVERED: 430DATE UST PERMANENTLY CLOSED: I. FACILITY INFORMATION 1 FACILITY ID#(Agency Use Only) - - 4 F3 4] 3 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) Valero Corner Store #3698 BUSINESS SITE.ADDRESS 103 CITY l0a 153 E. II"Street I Trac II.TANK DESCRIPTION TANK ID# 3698-3 432 TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK IS 434 Modem Welding E 1.A STAND-ALONE TANK ❑2.ONE IN A COMPARTMENTED UNIT. Com fete one pagefor each cum artmeo .' DATE h .'DATE UST SYSTEM INSTALLED a35 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 10/01/1997 10,000 III.TANK USE AND CONTENTS TANK USE M la.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ Ic.AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Inclua Uwd Oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§25791,5(c)I [16.OTHER GENERATOR FUEL ❑ 95.UNKNOWN [199.OTHER (Specify): 4390 CONTENTS PETROLEUM: ❑ Ia.REGULAR UNLEADED L] Ic.MIDGRADE UNLEADED M Ib.PREMIUM UNLEADED 440 ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM (specify): 4404 NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL n ❑ 11.OTHER NON-PETROLEUM(Specify): IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL M 2.DOUBLE WALL ❑ 95.UNKNOWN a43 PRIMARY CONTAINMENT M I.STEEL ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444 ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER (specify): 444a SECONDARY CONTAINMENT ❑ 1.STEEL LJ 3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445 ❑ 90.NONE ❑ 95.UNKNOWN M 99.OTHER(specify): FRP coated steel 445. OVERFILL PREVENTION M 1.AUDHJLE&VISUAL ALARMS ❑ 2.BALL FLOAT ❑ 3.FILL TUBE SHUT-OFF VALVE 452. ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ I.SINGLE-WALLED M 2.DOUBLE-WALLED [199.OTHER 464 SYSTEM TYPE M 1.PRESSURE ❑ 2 GRAVITY ❑ 3.CONVENTIONAL SUCTION LJ 4.SAFE SUCTION[23 CCR§2616(a)(3)I 459 PRIMARY CONTAINMENT Li 1.STEEL M 4.FIBERGLASS ❑ &FLEXIBLE ❑ HI RIGID PLASTIC 464 4641, [190.NONE ❑ 95.UNKNOWN [199.OTHER(Specify) SECONDARY CONTAINMENT ❑ 1.STEEL M 4.FIBERGLASS [18.FLEXIBLE ❑ 10.RIGID PLASTIC 464, ❑ 464, 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): PIPING(IURBINE CONTAINMENT SUMP TYPE M L SINGLE WALL ❑ 2.DOUBLE WALL [1 90.NONE 4"d VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ 1.STEEL M 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 461c 46 'l VENT SECONDARY CONTAINMENT ❑ L STEEL ❑ 4.FIBERGLASS ❑ I0.RIGID PLASTIC M 90.NONE ❑ 99.OTHER(Specify) 464r 4n VR PRIMARY CONTAINMENT ❑ L STEEL M 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 4648 4MLL VR SECONDARY CONTAINMENT ❑ I.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC M 90.NONE ❑ 99.OTHER(Specify) 464h 464hl VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL M 90.NONE 464. RISER PRIMARY CONTAINMENT M L STEEL EJ4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 4641 464'1 RISER SECONDARY CONTAINMENT _j 1.STEEL M 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464k 46441 FILL COMPONENTS INSTALLED M I.SPILL BUCKET M 3.STRIKER PLATE/BOTTOM PROTECTOR M 4.CONTAINMENT SUMP 451a-c VII.UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE. M 1.SINGLE WALL _j2.DOUBLE WALL [33.NO DISPENSERS [1 90.90.NONE 469hc CONSTRUCTION MATERIAL M L STEEL L14.FIBERGLASS [I10.RIGID PLASTIC LJ 99.OTHER(Specify) VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT M 6.ISOLATION aax. IX. APPLICANT SIGNATURE CERTIFICATION: I certify that this UST system is compatible with the hamrdous substance stared and that the information provided herein is true,accurate, and in full com Bance with al re uirements. 430 APPLICANT SIGNATURE ATE 401' APPLICANTTIT E Com liance Coordinator APPLICANT NAME(print) Sandy Huff P Rev.(12/2007) UPCF LIST.R-1/1