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NIFIED PROGRAM CONSOLIDATED FLT!M UNDERGROUND STORAGE TANK 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 this section and Sections I,II,III,IV,and IX below) 430 E 1.NEW PERMIT N 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ S.UST REMOVAL DATE UST PERMANENTLY CLOSED: 4J0a I DATE EXISTING UST DISCOVERED: 430h I. FACILITY INFORMATION FACILITY ID N(Agency Use Only) 2_ 114 111+ 1 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) p n O S-3-4,5, I n 3 EMT HARNEY ARCO I 1'� BUSINESS SITE ADDRESS 101 CITY IN 255 E.HARNEY LANE LODI U.TANK DESCRIPTION TANK ID N 432 TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK IS 434 _ _ ❑I.ASTAND-ALONE TANK 3 T/, 05 20 (�.� 2.ONE M A COMPARTMENTED UNIT. 1 XERXES C Ine one pap for each com tin rhe mt. DATE UST SYgTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 N/A 12, 000 2 III.TANK USE AND CONTENTS TANK USE N I a.MOTOR VEHICLE FUELING ❑ lb.MARINA FUELING ❑ I..AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used oil) ❑ 5.EMERGENCY GENERATOR FUEL[NSC§25261.5(c)J ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 43% CONTENTS PETROLEUM: ❑ la REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED Ib.PREMIUM UNLEADED llo ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM S eci : 44na NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM S eci : 44oh IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL E 2.DOUBLE WALL ❑ 95.UNKNOWN 443 PRIMARY CONTAINMENT ❑ L STEEL E 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 4E4 ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 444e SECONDARY CONTAINMENT ❑ L STEEL E 3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445 ❑ 90.NONE ❑ 95.UNKNOWN [199.OTHER S xi 445% OVERFILL PREVENTION I.AUDtBLE&VISUAL ALARMS 0 2.BALL FLOAT i 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-WALLED E 2.DOUBLE-WALLED ❑99.OTHER 460 SYSTEM TYPE 1.PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR J2636(a)(3)] 4511 PRIMARY CONTAINMENT ❑ 1.STEEL 0 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Spmify): 464. SECONDARY CONTAINMENT ❑ 1.STEEL 0 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ !0.RIGID PLASTIC 464h ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c PIPINGTrURBINE CONTAINMENT SUMP TYPE ❑ 1.SINGLE WALL 0 2.DOUBLE WALL ❑ 90.NONE 464d VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ 1.STEEL E 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 4M 464e1 VENT SECONDARY CONTAINMENT ❑ 1.STEEL 0 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464f 46an VR PRIMARY CONTAINMENT L1 1.STEEL 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 4646 464'i VR SECONDARY CONTAINMENT ❑ 1.STEEL 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464h 464hl VENT PIPING TRANSITION SUMP TYPEL SINGLE WALL 2.DOUBLE WALL [190.NONE 4641. RISER PRIMARY CONTAINMENT 1.STEEL ❑ 4.FIBERGLASS 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464'xI" RISER SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464k 4Mkl FILL COMPONENTS INSTALLED IF 1.SPILL BUCKET M 3.STRIKER PLATE/BOTTOM PROTECTOR N 4.CONTAINMENT SUMP 451h< VII.UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ❑ 1.SINGLE WALL 0 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469a CONSTRUCTION MATERIAL ❑ 1.STEEL 0 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 4696-c VIII. CORROSION PROTECTION ,-,-a STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATIQN ua_ IX. APPLICANT SIGNATURE CERTIFICATION: 1 certify that this UST system is compatible with the hazardous substance stored and that the information nvided herein is true,accurate, and in full compliance with legal requirements. f APPLICANT SIGNATURE ,rt_, 2/45/13 470, 4 APPLICANT NAME(print) Jonathan Ramos 471' APPLICANT TITLE Design Engineer 471 UPCF UST-8-1/2 (i Rev.(1212007)