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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK l 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,11,III,IV,and IX belo °3 ❑ 1.NEW PERMIT ❑ 3.RENEWAL PERMIT 5.CHANGE OF INFORMATION 1 � , 6.TEMPORARY UST CLOSURE 7.UST PERMANENT CLOSURE ON SITE 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 4J0i DATE EXISTING UST DISCOVERED: 10/4/13 43M 1. FACILITY INFORMATION FACILITY ID#(Agency Use Only) _TT_ - BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) Caltrans 3 BUSINESS SITEADDRESS ys, --- - 103 CITY Stockton JIS? 46 IN IL TANK DESCRIPTION TANK ID# 432 TANK MANUFACTURER 013 rTr�AANKCONFIGURATION: THIS TANKIB 434 Unknown LJ I.A STAND-ALONE TANK zak� ❑2.ONE IN A COMPARTMENTED UNIT. Came ane f. & uaa wiL DATE UST SY4&N& J.STALLED 435 TANK CAPACITY IN ALLLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 150 ea. III.TANK USE AND CONTENTS TANK USE ❑ Is.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ le.AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE q 4.HAZARDOUS WASTE(tn ULd Oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC¢252M N.)I ❑ 6,OTHER GENERATOR FUEL (!1 95.UNKNOWN ❑ 99.OTHER (Specify): 43% CONTENTS PETROLEUM: ❑ 1&REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ❑ Ib.PREMIUM UNLEADED 440 ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION CAS ❑ S.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM 3g i o Contents 4,w, NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL 09 I L OTHER NON-PETROLEUMS ): U31k11Own 4406 W. TANK CONSTRUCTION TYPEOFTANK 0 LSINGLEWALL ❑ 2.DOUBLEWALL [1 95.UNKNOWN 443 PRIMARY CONTAINMENT LJ3 I.STEEL ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444 ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER (Spec : : 444a SECONDARY CONTAINMENT ❑ 1.STEEL ❑3.FIBERGLASS ❑ EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445 ❑ 90.NONE ❑ 95.UNKNOWN99.OTHER5 cify): None "5sOVERFILL PREVENTION LAUDIBLE&VISUAL ALARMS 2.B L OAT 3.FILL TUBE SHUT-OFF VALVE 452, ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT NONE V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑1.SINGLE-WALLED ❑2.DOUSLEWALLED [199.OTHER NONE 460 SYSTEM TYPE ❑ 1.PRESSURE ES 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION tD CCR j2W6(sH)J 459 PRIMARY CONTAINMENT ❑ L STEEL ❑ 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 4M ❑ 90,NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): a64. SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ &FLEXIBLE ❑ 10.RIGID PLASTIC 4646 0 90.NONE ❑ 95.UNKNOWN .OTHER($pecffy): 464c PIPING/TURBINE CONTAINMENT SUMP TYPE ❑ LSINGLE WALL Lj 2.DOUBLE WALL tj 90.NONE 46m VL VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ I.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC EI 90.NONE ❑ 99.OTHER(Specify) 464e 46k1 VENT SECONDARY CONTAINMENT ❑ 1.STEEL E3 4.FIBERGLASS ❑ 10.RIGID PLASTIC 90.NONE 99.OTHER(Specify) 464f 464n VR PRIMARY CONTAINMENT ❑ 1.STEEL 4.FIBERGLASS ❑ 10.RIGID PLASTIC El 90.NONE 99,OTHER(Specify) 464s 46t I VR SECONDARY CONTAINMENT I.SFEEL 4.FIBERGLASS 10.RIGID PLASTIC E3 90.NONE C1 99.OTHER(Specify) 464h 464h1 VENT PIPING TRANSITION SUMP TYPE LE It 2.DOUBLE WALL 90.NONE 4641 RISER PRIMARY CONTAINMENT ❑ I.STEEL 4.FIBERGLASS 10.RIGID PLASTIC 90.NONE ❑ 99.OTHER(Specify) 464j 6'l RISER SECONDARY CONTAINMENT I.STEEL 0 4.FIBERGLASS 10.RIGID PLASTIC 90.NONE 0 99.OTHER(Specify) 4644 46441 FILL COMPONENTS INSTALLED 1.SPILL BUCKET 0 3.STRIKER PLATFIBOTTOM PROTECTOR 4.CONTAINMENT SUMP UNICIOWN 451.-c VIL UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE [§ 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469a CONSTRUCTION MATERIAL 1.STEEL ❑ 4.FIBERGLASS 0 10.RIGID PLASTIC 99.OTHER(Sped ) 4696e VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION 446 IX. APPLICANT SIGNATURE CERTIFICATION: 1 certify Ill 1 is UST system is compatible with the har3,rdous substance stored and that the information provided herein is true,accurate, and in f core lienee with legal requirements. APPLICANT SIGNATURE DALE 470 10-17-13 APPLICANT NAME(pHnt) Tim Lane 471_ APPLICANTTITLE Director/Agent 472, U PCF UST-B-I/2 Rev.(12/2007)