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At CA &� UNIFIED PROGRAM CONSOLIDATED FORM 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 l 11.111, 1V,and 1X helow) 439. ❑ I.NEW PERMfr ❑ 3.RENEWAL PERMIT ® 5.CHANGE OF INFORMATION El 6.TEMPORARY UST CLOSURE ❑ T UST PERMANENT CLOSURE ON SITE Q 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: -- I DATE EXISTING UST DISCOVERED: 45W. I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) _ _ / L BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 5 USA/Tesoro 68154 BUSINESS SITE ADDRESS 103 CFI Y 1w. 2500 W. Lodi Ave. Lodi II. TANK DESCRIPTION TAN,K ID# e32 TANK MANUFACTURER 433 TANK CONFIGURATION:I'HISTANK IS 434. iAo%m Modem oe Welding Ej® 2.ONE INA COMPARTMENTED UNIT crymnmALONE TANK c-'I.. M lIM e roe ach m io 1., DATE UST SYSTEM INSTALLED 435 1 TANK CAPACITY IN GALLONS 4.14. NUMBER OF COMPARTMENTS IN THE UNIT 427 Unknown 12,000 1 III. TANK USE AND CONTENTS TANK USE ® la.MOTOR VEHICLE FUELING [I IF MARINA FUELING ❑ ]c.AVIATION FUELING 459. ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE a1dude4U> QB ❑ 5.EMERGENCY GENERATOR FUEL[HSC§252315(c)] ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(SPecif�): 409+ _..____ __".___ ___ ".___..._.___ .___..__ ________ ________.._ _.._.__. CONTENTS PETROLEUM ❑ la.REGULAR UNLEADED Ia r MIDGRADE UNLEADED ❑ Ib.PREMIUM UNLEADED ao ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM(Specify): 44a ________ .--____-_ _.. _.__ NON-PETROLEUM � ] USED OIL ❑ 10.ETHANOL ❑ 11 OTHER NON-PETROLEUM(Specify): 14% IV. TANK CONSTRUCTION TYPE OF TANK ❑ I.SINGLE WALL M 2 DOUBLE WALT. ❑ 95.UNKNOWN 443. PRIMARY CONTAINMENT ® 1.STEEL 11J.FIBERGLASS ❑ 4.INTERNAL BLADDER 444_ ❑ 7.STEEL•INTERNAL LINING ❑ 95.UNKNOWN__ C199_OTHER IS�ecity): 4ua SECONDARY CONTAINMENT ❑ I.STEEL El 3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ® 7.JACKETED d05 ❑ 90.NONE O 95 UNKNOWN ❑99.OTHER(Specify): 441. ________ __._____. __."___._ ____ ____ _ _.. 412 OVERFILL PREVENTION ® I.AUDIBLER VISUAL 4LARMS ® '_.B.ALL FLOAT ❑ 3.FILL TUBE SHUT-OFF VALVE ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ 1.SINGLE WALL ® 2.DOUBLE WAIL 0 'N.OTHER 460 _SYSTEM-TYPE ® 1.PRESSURE ❑ 2 GRAVITY ❑ 3_CONVENTIONAL SUCTION Q 4 SAFESUCTION Iv CCR J2616(Xa)I 453. PRIMARY CONTAINMENT ❑ I.STEEL ❑ 4.FIBERGLASS ® 8.FLEXIBLE ❑ 10.RIGID PLASTIC 444. ❑ 90 NONE__ _ _ EI 95.UNKNOWN 0.99.OTHER(Spai�y 464a ._" _.--__ ._ - -i6f SECONDARY COM-AINMENf ❑ I.STEEL ❑ 4.FIBERGLASS ® S.FLEXIBLE 10,RIGID PLASTIC ❑ 90.NONE 0 95 UNKNOWN ❑ 99.OTHER(Specif)'1. 4N°_ PIPINGlTURBINE CONTAINMENT SUMP TYPE I SINGLEWUL ❑ '.DOUBLE WALL ® m.NONE 464d VI. VENT,VAPOR RECOVERY (VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ LSTEEL ® 4.FIBERGLASS ❑ 10 RiG10PL:\STIC ❑ 90.NONE ❑ W OTHER(Specify P. 6( VENT SECONDARY CONTAINMENT ❑ L STEEL ❑ 4 FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE C199 0FHER(Specify) 444[ .. ------_-- .94n._ VR PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specuy): 44641t VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS E310.RIGID PLASTIC ® 90.NONE (399.OTHER(Specify): 4Mhl VENT PIPING TRANSITION SUMP TYPE ❑ I.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE 460. RISER PRIMARY CONTAINMENT ® I.STEEL 0 4 FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90 NONE ❑ 99 OTHER(Spemfy): RISER SECONDARY CONTAINMENT ❑ L STEEL IX 4 FIBERGLASS ❑ 10.RIGID PLASTIC ® 90 NONE ❑ 99 OTHER(Specify): 446hh,_ FILL COMPONENT$INSTALLED 19 L SPILL BUCKET ® 3.STRIKER PLA(F7BOTTOM PROTECTOR ® 4.CONTAINMENT SUMP 45ieti. VII. UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ® I.SINGLF WAIL ❑ 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE " aaz= CONSTRUCTION MATERIAL ❑ 1 STEEL ❑ 1 FIBERGLASS ® 10 RIGID PLASTIC ❑ 99.OTHER(Specify) VIII. CORROSION PROTECTION Q7 STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODES) ❑ 4.IMPRESSED CURRENT ❑ 6"ISOLATION IX. APPLICANT SIGNATURE CERTIFICATION: 1 certify that this UST system is compatible with the hazardous substance stored and that the information provided herein is accurate,and in NII compliance with 1 al re uiremenis. APPLICANT SIGNATURE S DATE 8/3/2009 _ 47 0. APPLICANT NAME(print)"Sandy Ed dS 4v1. APPLICANT TITLE Environmental Compliance UPCF UST-B Rev.(12(2007)-12 www.unidocs.mg