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�./N'IFIED PROGRAM CONSOLIDATED FOK*4 UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION- TANK INFORMATION (Onc Ib(m Pet UST) 'FYPF OF ACTION (C-heck nor item ooh'. F'nr a UST closure or removal,cnmp/etr anh,this,,ctinn and.Sections 1.H.W.l F,and IX below) +u' ❑ I NEW'PF::RMI"I' �' KI'NIIWAI.PIiRMff ❑ .5.Cl IANGE OF INFORMA PION '-' G.TEMPoRAR'i US i'CLOSURiI uil:ii7iinrvi,liJiiiJTCiliSURF.ON Si ffi '-' S.US f n{iMOVAi. It I I:ST PI'RMA NFN'1'LY CI OClil) nna IL1'llI:XIS"I'INr'I IS'('DISC'(rvIBFp I L FACILITY INFORMATION FAC'l1.ITY IU#IAgenry Usv(In/vl ` � O O Q _ � S i 13USINF.SS NAME(Same a,/•trei/iry N'ameor DBA •r /)asines,<d.c) I. O ! ¢7111Y HU INFSS SI'FI(ADDRESS 191 ^ uu Sb IAI H. TANK DESCRIPTION I:ANK IDE +)= 'TANK MANUFACHIRER 411 7IIANKCONFIGURATION:'IIiIS'1'ANKI$ 4� o4 0 D2�DS rl(.O p L A S'1'ANI}ALONL:TANK (rompinc wie Poeee an eaM1 )V ❑ 2.ONH INA COMPAR'IMRN'fLDUNI'1' romwrmwr�nn se unn DAIT US"[ SY.'1'F.M INSTALLP:D +14 'TANK('A IWl I IN GA I.[ON S +1'• NLIMBF.ROFCOMPAR'I'MENI'S IN'I]IF IINI'I' +17 3 1 I S D,(,- IIL TANK USE AND CONTENTS YANK USE ❑ la.MOI OR VEHI('Lli FIIFLING Ib.MARINAFUEHNG ❑ lc.AVIATIONF(1FLING +)" ❑ 3.CHEMICAL PRODUCESI'GRAGI! y IIALARIX)IISWASII!(lnclW L,aft)III 05.EMERGENCY GENERATOR FUEL 111% 4'_4281 Acll Cl G.OTHER GENERATOR HT]. [1 95.UNKNOWN 99,OTIIFR(Specify): +)'h _........E CON'I'FNTS PF7ROLFUM: ❑ la.RF:GIILAR UNLEADEDAg1,MIfXiRAUP.UNLEADED [IIb.PREMIUMUNLEADED +u' ❑ 3.DIPSEE ❑ 5.)Effllll. ❑ 6.AVIA'OONOAS ❑ R.PHIROLEUMBLENUFUI(I. 04.0'1'111111 PlCl'ROL1!IlM ltipecify): tuh NON-PFSROI.F.IIM: 7.OSEDOIL 0 1,F"I'IIANO. ❑ 11 O`ITIF.R NON-PE-rROLF.(IM(S=ir). 4416 IV. TANK CONSTRUCTION IYPI'.OFTANK ❑ LSINGLFWAH E.,2.=1131.1 WALL ❑ 95.UNKNOWN ++I PRIMARY CON'IAINMF.NI' $ I.S'fFF.l. ❑ 3.FIBE:RCi ASS ❑ 6.1NI'FRNAL HLADDF.R +++ ❑ 7.SIYFI. INTI':RNAL LINING ❑ 45.UNKNOWN ❑ 'W.GEI 1ER SECONDARY CON TAINMIiNT I,SI}ail. FIBERGLASS ❑ 6.DOERIOR MEMBRANE LINER� 0 )Jn('KI"I'FU ++5 ❑ 90 NONE: ❑ 95.UNKNOWN I�w)ontER(Specoy): �jgpµ�{IAF�f CB/F{E(1 � (�+45+ GVERFILl.PRF-VFNTION ❑ I.AUDIBEI &VISUAL ALARMS 2.FALL FLOAT .K 3.FILL-RIRF SHLI'f-OFF VALVE ❑ 4.'fANK MEFIS RFO(IIRV.MFN'I'S FOR P:XFMVIION FROM OVERFILL PRL:VF:N"PION I.QUIPMWI V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION I.SINGLI•W AL1. )$.2.DOUBLE':WALT. ❑ 99.OTHER J1+' SYSTEM TYPE �$ I.PRFSSURII ❑ LGkAVI"IY ❑ 3.('ONVEN IONAI.SIIGFION [14 SAFE S(1(-RON 1')CCR,±u)q+en1 .15R PRIMARY CON'I"AINMEN I' ` I.S FIT Ig n.FuaExGLASS ❑ x.1 EFXII l.0 ❑ HI RIc10 PI.Asn(' +'a D w.NONE. ❑ 95.UNKNOWN ❑ 99.o'funR(SPecay) ua, SECOND.ARYCONTAINMENT ❑ LS'I'F:FI. 44.1'IIIER(II.ASS ❑ x.FL F.YIBI 1: ❑ 10.RICIUPLAS'OC +rax 49.NONE.. 095.UNKNOWN ❑ 99.(11'm R(Speeit'p uac PIPING,TURHINF.CONTAINMENT SAME."I"YPfi rkL I.SINGLE:WALT. liad ❑ 21XXiBLP:WALE. ❑ W.NONI'. VI. VENT,VAPOR RECOVERY (VR)AND RISER/ FILL PIPE PIPING CONSTRUCTION VENT PRIMARYCON'I'AINMEMI' JIL I S'EHI ❑ 4 I:IBFROLASS ❑ 19.RICIUPLASI IC ❑ w).NONE ❑ 99.GI'HER(Spcd51' .w. VENI-SECONDAR}'CONIAINMEN'I I.S"flllfl. ❑ 4.FIBERGLASS ❑ I0.11I01I)P.AS'fl(' 9a.NONE ❑ 99.OmER(Sp�nfyl: +M( aP VR PRIMARY CONTAINMf:NT --I.SI'I:F:I. ❑ 4.19(iI:K01 ASS ❑ IU.RI(iI)ELAS"Il(' W1.NONE ❑ 9V.(71'HI_R(Spw:ifyt uayl VR SECONDARY CON'IAINMENf I SEFEI ❑ 4 IIIiIRU ASS ❑ 10,RIGID PIASTI(' �I WI NONE 0 W OTHER=if I- 4 VENuaM1 RISE PIPING TRANSITION SUMP'I'\'PP 1 NN(RE. AS 1. ❑ 2IHI HI a.w SI I. 0 JKIX) NONE: ■ �`-/1 VED RIS{R PRIMARY CONTAINMFNI � 1 S11'P:1 Q 4 I Ilii RUIASS ❑ I(1.RI(ID I I ASll(' ❑ w) NONE � 99(YfI IE ■\`-+1_" RIS[RSFCONDARY CON'f.A1NMEN1 ❑ I SIFLI ❑ I I im RGL\SS ❑ III RimmvI A.tim }$'rtI MINE ❑ 1H) (11HI(R,,,,, Ei _- I-II L(UM!'UNF.N IS INSI ALLIiU SIVA III:( K, 1 ' �l- INFRI.IAII/IX)Ilun-I"R li _Ilu ^"''-` 1 -_-_ Q>S ❑ 4 ('DN"1'AINMIiNI sl�htl• VIL IINIDFR I)ISPFN'4'R CON UAINNMFN 10 :0C) JAN 1-5 2013 jG SAN JOAQUIN COUNTY ENVIRONMENTAL �1iEALTH DEPARTMENT X v� �- ANGAS'N