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nc. l*wgED PROGRAM CONSOLIDATED FOh SA(A UNDERGROUNDSTORAGETANK OPERATING PERMIT APPLICATION- TANK INFORMATION (one form per UST) TYPE OF ACTION (Check one item only. For a UST closure or removal,complete only this section and Sections 1,O,III,IV,and IX below) 439. ❑ I.NEW PERMIT ❑ 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ S.UST REMOVAL DATE UST PERMANENTLY CLOSED: 430., 1 DATE EXISTING UST DISCOVERED: 430b. I. FACILITY INFORMATIONE7-reN FACILITY ID#(Agency Use Only) _ §, ;t t. BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) FLAG CITY ARCO/SUBWAY BUSINESS SITE ADDRESS 103. CITY z 104. 14931 NORTH FLAG CITY BLVD. LODI, CA 95242 II. TANK DESCRIPTION TANK ID# 432- TANK MAN�EE ACTUAER 433. TeqJN34K CONFIGURATIONiiEq(.$ 434. TA0506222 D wti„s CorNtn Iy1.ASTAND-ALONE TANK Al Complete Corm Complete one page for each ❑ 2.ONE INA COMPARTMENTED UNIT compmmeu in the it DATE UST SYSTEM INSTALLED 435. TANK CAPACITY M GALLONS 430- NUMBER OF COMPARTMENTS IN THE UNIT 437. 4/1/1997 20,000 III. TANK USE AND CONTENTS TANK USE ® la.MOTOR VEHICLE FUELING ❑ lb.MARINA FUELING ❑ lc.AVIATION FUELING 439. ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Intimi a U.ed Oil ❑ 5.EMERGENCY GENERATOR FUEL[HSC§252815(c)) ____-❑ 6.OTHER GENERATOR FUEL [I9$_UNKNOWN ❑_99._OTHER(Specfy)_. 439.. CONTENTS PETROLEUM: ® la REGULAR UNLEADED ❑ Ic.M[DGRADE UNLEADED ❑ Ib.PREMIUM UNLEADED 440. ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8 PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM(Specify): 440.. NON-PETROLEUM❑ 7 USED OIL ❑ 10.ETHANOL ❑ 1 I.OTHER NON-PETROLEUM(Specify): 440b. IV. TANK CONSTRUCTION TYPE OF TANK ❑ I.SINGLE WALL ® 2.DOUBLE WALL ❑ 95.UNKNOWN M3. PRIMARY CONTAINMENT ❑ 1.STEEL ® 3 FIBERGLASS ❑ 6.INTERNAL BLADDER 444_ ❑ 7 STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99 OTHER(Specify): 444a_ SECONDARY CONTAINMENT ❑ I.STEEL ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445 ❑ 90.NONE ❑ 95.UNKNOWN [:199.OTHER(Specify): OVERFILL PREVENTION ❑ 1 AUDIBLE&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 ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 99.OTHER 469. ____--- .-_ .. -... ........_... _.._ - ............ SYSTEM TYPE _ ® LPRESSURE ❑ 2 GRAVITY__ ❑ 3;CONVENTIONAL SUCTION_O._4SAFE.SUCTION 123 CCR§2e36(a)(3)1 4sa. PRIMARY CONTAINMENT ❑ i.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify)_:_ SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 8 FLEXIBLE ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 4(W PIPINGl1'URBINE CONTRINMENT SUMP TYPE ❑-L SINGLE LL WA ® 2.DOUBLE WALL ❑ 90.NONE 4646. VI. VENT,VAPOR RECOVERY (VR) AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ I STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): b 4e1' VENT SECONDARY CONTAINMENT ❑ L STEEL ®.4 FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify); 4648 VR PRIMARY CONTAINMENT ❑ 1 STEEL ® 4 FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90 NONE ❑ 99.OTHER(Specify): 44", VR SECONDARY CONTAINMENT ❑ 1 STEEL N 4 FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): a6abbr, ...... ...... _._._- ___ ......._ ... ..___- VENT PIPING TRANSITION SUMP TYPE _ IL I SINGLE WALL6ii (I 2 DOUBLE WALL ❑ 90 NONE 4 RISER PRIMARY CONTAINMENT ❑ I STEEL ® 4 FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 46Pj, ........... .. ........... .-.-__-. .. ._. .-----.... _._._ .-.-........-... .....____ _.._i__- RISER SECONDARY CONTAINMENT ❑ I STEEL M 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 46Gk_ FILL COMPONENTS INSTALLED ❑ L SPILL BUCKET ❑ 3.STRBCER PLATE/BOTTOM PROTECTOR ❑4.CONTAINMENT SUMP 451.r:'"' VII. UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE 1& 1 SINGLE WALL _ -_13 2.DOUBLE WALL [1 3.NO DISPENSERS ❑ 90.NOS 469.. ...___._.____. _ _ __-_._.-. .-.____ ... ...______ _. CONSTRUCTION MATERIAL ❑ 1 STEEL ® 4 FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 46% 46%, VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION - 448 IX. APPLICANT SIGNATURE CERTIFICATION: 1 certify a thi U stem is compatible with the hazardous substance stored and that the info atlon provided herein is true, accurat , i ul c liance with legal re uiremenis. bi•^ APPLICANT SIGNATURE APPLICANT NAME(print) I HALLOUM 471_ APPLICANT TITLE OWNER 472' UPCF UST-B Rev.(12/2007)-1/2 www.unidoes.org