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2j7(4(0-1 Our,- UNIFIED PROGRAM CONSOLIDATED FORM Get �SIfG'Z1�9' UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION(one torm "USTI TYPE OF ACTION (Check one item only. Foran UST pertnanen(closure or removal,complete only this section and Sections I,it,111,IV,and IX below) 4A1 ❑ I.NEW PERMIT ® 3.RENEWAL PERMIT ❑ 5.CHANGEOF INFORMATION 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE 8.UST REMOVAL _ DATE UST PERMANENTLY CLOSED: J30e DATE EXISTING UST DISCOVERED. i0b 1. FACILITY INFORMATION FACILITY IDW(Agenry Use Only) _ 1 - 117 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) ) Valley Pacific Petroleum Cardlock-Shane and Doves BUSINESS SITE ADDRESS 11O CITY I04 3550 S Hwy 99 Stockton II.TANK DESCRIPTION TANKID 432 TANK MANUFACTURER 411 TANK CONFIGL'RAI'ION: THISTANKIS 134 ❑L A STAND-ALONF TANK I Modern Welding ®2,ONE IN A COMPARTMENTED UNIT Com dome ar 4am mm du rse dol. DATE UST SYSTEM INSTALLy95 435 TANK CAPACITY IN GALLONS 416 NUMBER OF COMPARTMENTS INTHE UNIT Z 1J7 9,000 III.TANK USE AND CONTENTS TANK USE Ia.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING. ❑ le.AVIATION FUELING 430 ❑ 3.CHEMICALPRODUCT STORAGE ❑ 4.HAZARDOUS WASTE ordu use4 On) ❑ 5.EMERGENCY GENERATOR FUEL IHSC 4zs2,LM11 ❑ 6.OTHER GENERA TOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER $ i ): 4398 CONTENTS PETROLEUM: 09 Is,REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ❑ Ib.PREMIUMIMLEADED J40 ❑ 3.DIESEL ❑ 5.JET FUEL. ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM (Spqein,a NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ II.OTHER NON-PFTROLEUM S ,i," 44W IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1,SINGLE WALL IN2.DOUBLE WALL 95.UNKNOWN 443 PRIMARY CONTAINMENT DA I.STEEL ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444 ❑ 7.STEEL.INTERNAL LIKING ❑ 95.UNKNOWN ❑ 99 OTHER S - 444a SECONDARY CONTAINMENT E] 1.STEEL 3.FIBERGLASS E36.EXTERIOR MEMBRANELINER ❑ 7.JACKETED 448 ❑ 90.NONE ❑ 95,UNKNOWN ❑99.OTHERS i : 4454 OVERFILL PREVENTION 1.AUDIBLE&VISUAL ALARMS 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-WALLED2.DOUBLE-WALLED ❑99.0'rHFB 4N1 SYSTEMTYPE LPRESSURE ❑ 2.GRAVITY ❑ 3.CONVEN'IONAL.SUCDUN ❑ 4.SAFE SUCTION 123 CCR§206(MO)I 459 PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIOID PLASTIC 484 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(S iffy j1i4a SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ S.FLEXIBLE ❑ 10.RIGID PLASTIC 4x'46 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER($ i ): 4a` PIPINGffURBINE CONTAINMENT SUMP TYPE I.SINGLE WALL ❑ 2.WUBLE WALL ❑ W.NONE 4x44 VL VENT,VAPOR RECOVERY(VR)ANDR►SER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT I.STEEL 4.FIBERGLASS I9.RIGID PLASTTC U W.NONF. 9".CTHER(Spmiry) 464e 46h1 VENT SECONDARY CONTAINMENT ❑ I.STEEL 4.FIBERGLASS ❑ 10.RIGIDPLASTIC 90.NONE 1299.OTHER(Spseify) 4W1 464n VR PRIMARY CONTAINMENT D I.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC 90.NONE 99.OTHER(Spddfy) 4464, VR SECONDARY CONTAINMENT 1.STEEL 04.FIBERGLASS ❑ 10,RIGID PLASTIC a W.NONE 0 99.OTHER(Speeify) 4616 4lAbl VENT PIPING TRANSITION SUMP TYPE M I.SINGLE WALL n 2.DOUBLE WALL. 90.NONE 4Ni_ RISER PRIMARY CONTAINMENT 1.STEEL SS 4.FIBERGLA10.RIGID PLASTIC 90,NONE LJ 99 OTHER(Specify) 46IMi iJ c 5 RISER SECONDARY CONTAINMENT 1.STEEL 4.FIBERGLASS 0 10.RIGID PLASTIC 90.NONE 99.OTHER(Specify) 4Nt u.+kl .n.,... FILL COMPONENTS INSTALLED 1XI.SPILLBUCKET 3.STRIKF.RPLATVBOTTOMPROTECIOR 0 4 CONTAINMENTSUMP VIZ.UNDER DISPENSER CONTAINMENT(UDC) 1'•my=� ('ONSIRU("[ION'fYPE I.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 3,NO DISPENSERS [3 90.NONE J1`1° 'MWS CONSTRUCTION MATERIAL 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(S i J1`""` I• r VEIL CORROSION PROTECTION STEEL COMPONENT PROTF.0 TION ❑ 2.SACRIFICIAL ANODES) ❑ 4.IMPRESSED CURRENT KI 6,ISOLATION IX. APPLICANT SIGNATURE CERTIFICATION: 1 certify that this UST system is compatible with the hazardous substance stored and that the information provided hereto is true,accurate, and in full compliance with legal requirements. 470 APPLICANT SIGNATUDATE 3123/09 APPLICANT NAME(print) 411- APPLICANTTITLE 472. Mike Elision Cardlock Manager IIPCF UST-B-12 Rev.(122007)