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FIED PROGRAM CONSOLIDATED F OPERATING PEST AGROUND STORAGE TANK TYPE OF ACTION (Check one item onl . APPLICAT ION-T � X L NEw PERMIT 1 For an UST e TANK INFORMATION 29 a9 6 TEMPO P nnanent closure or removal,complete only (One form NARY UST CLOSURE 0 3.iEgWAL PERMIT y this section and per UST) DATE UST PE ❑ 7 UST PERMANENT CLOS ❑ 5.CHANGE ns I'II,III,IVand below) RMANENTLY CLOSED: URE ONSITE OF INFORMAIX w) TION 430 D COVERED VAL FACILITY ID H(Agency Use onlj) L FACILIT430a DATE EXISTING US EJ 8.UST lI Y INF O RMATION 4306 BUSINESS NAME(Same as FACILITY N Tower#87 AME or DBA-Doing Business As) - BUSINESS SITE ADDRESS 1 14000 E.H 88 103 CITY 3 TANK IDN H. TANK DESC Lockeford W CTURER 433 1 432 TANK MANUFq RIPTION �� '�� UNmown TANK CONFIGURATION: THIS TANK IS 01 X LA El DATE UST SYSTEM INSTALLED STAND-ALONE TANK 434 43s 2.ONE IN A conte TANK CAP Com . on.ONEIncARTMENTED UNIT. 12,000 ACITY IN GALLONS 136 NUI OF COMPgR�em 1n i e taut. 1 TWNTS IN THE UNIT III. TANK USE 437 TANK USE x ]a MOTOR VEHICLE FUELING AND CONTENTS 03* 3.CHEMICAL PRODUCT STORAGE I fib.MARINA FUELING ❑ 6.OTHER GENERATOR FUEL HAZARDOUS WASTE ❑ In.AVIATION FUELING CONTENT$ ❑ 95.UNKNOWN (Included Used Oil) ❑ 5.EMERGENCY G 439 PETROLEUM; z la.REGULAR UNLEADED ❑ 9910 ENERATOR FUEL[NSC§zszels(a)I ❑ 3.DIESEL ❑ ]c.MIDGRADE UNLEADED (Specify): 4391 ❑ Ib.P ❑ 8.PETROLEUM BLEND FUEL, ❑ 5"LET FUEL ❑ 6.AVIATION 440 NON-PEIROL.EUM:❑ 7.USED OTr ❑ 9"OTHER PETROLEUM (S city); ❑ 10.ETHANOL❑ 1 L OTLIBRNUN-PETROLEUM(S i ); 4401 IV. TANK CONSTRUCTION 440° TYPE OF TANK ❑ 1.SINGLE WALL x 2.DOUBLE WALL PRIMARY CONTAINMENT x 1.STEEL, ❑ 95.UNKNOWN ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 4l3 ❑ 7.STEEL,+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER 4" SECONDARY CONTAINMENT X 1.STEEL ❑ 3.FIBERGLASS ❑ 6.EXTERIOR MEhIBRANE LINER (S ]�) 444a ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER S ❑ 7.LACKEYED 4y5 OVERFILL PREVENTION ❑ 1.AUDIBLE&VISUAL ALARMS ( )' ase ❑ 2.BALLFLOAT x 3.REV TUBESHUT-OFF VALVE ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT 452. V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION F-11-SINGLE-WALLED x 2.DOUBL&WALLED ❑99.OTHER SYSTEMTYPE x L PRESSURE ❑ 2.GRAVITY460 ❑ 3. TLONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR§2636(.)(3)] PRIMARY CONTAIIffNf ❑ 1.STEEL X 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID] 458464 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.0'1'Fffi[t(Specify): 464a SECONDARY CONTAINMENT ❑ 1.STEEL x 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ VI RIGID PLASTIC 464b ❑ 90.NONE ❑ 95.UNKNOWN ❑ OTHER (Specify): 4Mc PIPINGAVRBINE CONTAINMENT SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464d VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ 1.STEEL z 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464. VENT SECONDARY CONTAINMENT ❑ 1.STEEL 464.1 x 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464f 464n VR PRIMARY CONTAINMENT ❑ 1.STEEL X 4.FIBERGLASS ❑ 10.RIGIDPLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 46ag 464 1 VR SECONDARY CONTAINMENT ❑ 1.STEEL X 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464h 4 VENT PIPING TRANSITION BUMP TYPE ❑ 1.SINGLE WALL x 2.DOUBLE WALL ❑ 90.NONE 4Mi 464.. RISER PRIMARY CONTAINMENT x 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGIDPLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 46,1 464'] RISER SECONDARY CONTAINMENT ❑ 1.STEEL x 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 46ak 464kl FILL COMPONENTS INSTALLED x 1.SPILL BUCKET x 3.STRIKER PLATFBOTTOM PROTECTOR x 4.CONTAINMENT SUMP 451.1 VII.UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE X L SINGLE WALL ❑ 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469. CONSTRUCTION MATERIAL ❑ 1.STEEL x 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 4691,c VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODES) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION 44s. LX. APPLICANT SIGNATURE CERTIFICATION: I certify that this UST system is compatible with the hazardous substance stored and that the information provided herein is true,accurate, and in full compliance with legal requirements. APPLICANT SIGNA DATE 670 APPLICANT NAME(print) Dulcinea Webb 471, APPLICANT TITLE Compliance Manager _ 472. UPCF UST-B-III Rev.(12/2007)