BILLING 2009 - 2012 - Laserfiche WebLink

Home Browse Search

UI LftrFIED PROGRAM CONSOLIDATED FOIA iZI 11 UNDERGROUND STORAGE TANK 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 I,If,111,IV,and IX beloov) 430. ❑ I.NEW PERMIT ❑ 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY USE CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 43°s_ DATE EXISTING UST DISCOVERED: 43%. I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) 1�: _ � ,, a ;, [ 1 BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3, FLAG CITY ARCO/SUBWAY MAY 9 + 2012 BUSINESS SITE ADDRESS 103, 1 CITY 104. 14931 NORTH FLAG CITY BLVD. LODI, CA 95242 II. TANK DESCRIPTION =r1, ,-0N IN:Tcl TANK ID# 432. TANK MANUFACTURER 433, TANK CONFIGURATI _ S ANK I 434. TA0506223 ❑ L A STAND-ALONE TANK Qna,le,e ane page for each ❑ 2.ONE M A COMPARTMENTED UNIT wmpart-w in the unit. DATE UST SYSTEM INSTALLED 035- TANK CAPACITY IN GALLONS 436, NUMBER OF COMPARTMENTS IN THE UNIT 431. 4/1/1997 10,000 III. TANK USE AND CONTENTS TANK USE ® la.MOTOR VEHICLE FUELING ❑ 1b.MARINA FUELING ❑ lc.AVIATION FUELING 439. ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC¢25281.5(c)I ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 439,. CONTENTS PETROLEUM: ❑ Ia.REGULAR UNLEADED ® lc MIDGRADE UNLEADED ❑ 1b.PREMIUM UNLEADED 440. ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8 PETROLEUM BLEND FUEL _[1 9_OTHER PETROLEUM(S_�p NON PELEU TROM [-I7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 4406- IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 95.UNKNOWN 443. PRIMARY CONTAINMENT ❑ I.STEEL ® 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444. ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 444. SECONDARY CONTAINMENT ❑ 1.STEEL ®3 FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445. ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specify): 445x LA . OVERFILL PREVENTION ❑ 1.AUDIBLE&VISUAL ARMS ❑ 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 WALL ® 2.DOUBLE WALL ❑ 99.OTHER 460_ SYSTEM TYPE ® I.PRESSURE ❑ 1 GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR¢2636(,)3)) 458. PRIMARY CONTAINMENT ❑ I.STEEL ® 4 FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464x. SECONDARY CONTAINMENT ❑ 1.STEEL ® 4 FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 4646. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464, PIPINGlFURBE CONTAINMENT SUMP TYPE [31.SINGLE WALL ® 2.DOUBLE WALL El90.NONE 464a IN _ VI. VENT,VAPOR RECOVERY (VR) AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ L STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): q4 l .._............._.. ............ ..............._ .______. ___.___. __.-___ __.._..._.... ............. ................ .........._. a 1 VENT SECONDARY CONTAINMENT ❑ L STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 463n_ Wig,._ VR PRIMARY CONTAINMENT ❑ 1 STEEL ® 4 FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90 NONE ❑ 99.OTHER(Specify): a64�_ VR SEC ONRY CONTAINMENT ❑ L STEEL ® 4.FIBERGLASS El10.RIGID PLASTIC [190.NONE [199.OTHER(Specify): 464h"' DA VENT PIPING TRANSITION SUMP TYPE 1 SINGLE WALL Q 2.DOUBLE WALL [190.NONE 464:- __ _......... ............ _.__.. RISER PRIMARY CONTAINMENT ❑ 1 STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): gfi44j- ...._..... ...__.__ ______. A RISER SECONDARY CONTAINMENT [1 1.STEEL ® 4.FIBERGLASS [I10.RIGID PLASTIC [190.NONE [1464k1. 99.OTHER(Specify): 464 k. _ ___ _ FILL COMPONENTS INSTALLED ❑ L SPILL BUCKET ❑ 3.STRIKER PLATFJBOTTOM PROTECTOR_ ❑ 4.CONCAINMENT SUMP 451a-°_ VII. UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE tq 1 SINGLE WALL Q 2 DOUBLE WALL ❑ 3. . _______.- _.e._.__........--------__... CONSTRUCTION MATERIAL ❑ 1.STEEL N 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) .T °ybyb_ VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIALANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION 44s IX. APPLICANT SIGNATURE CERTIFICATION: I certify t th, S system is compatible with the hazardous substance stored and that the info at[ provided IWrein is true, accura ,a d' om liance with legal requirements.APPLICANT SIGNATOR DATE .i( d -Z - j-�14770APPLICANT NAME(print) IF HALLOUM 411. APPLICANT TITLE OWNER UPCF UST- -Rev.(12/2007)-1/2 www.unidoes.org