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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION(one tormr UST) TYPE OF ACTION (Check one item re only. For an UST Permanent closure or removal,complete only this section and Sections I,11,III,IV,and IX below) +R' 0 I.NEW PERMIT ® 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE 7,UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 4194 I DA IT,EXISTING UST DISCOVERED'. +RIh 1. FACILITY INFORMATION FACILITY ID H(Agmey Use Only) _ 1 BUSINESS NAME(Same es FACILITY NAME,or DBA-Doing Business As) s I Valley Pacific Petroleum Cardlock-Shane and Doves BUSINESS SITE ADDRESS p1} CITY IIH 3350 S Hwy 99 Stockton r 11.TANK DESCRIPTION TANK ID O, DJ32 TANK MANUFACTURER +33 TAMC CONFiou"noN. THUS TANK IS JI+ ❑I.ASTAND-ALONE TANK 2 Modern Welding ®2.ONE IN A COMPARTMENTED UNIT. com moae r«tea iome mii. DATE UST SYSjEI$J ALLED_. +I5 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMF,NTS IN THE UNIT Jit �(vI 2 III.TANK USE AND CONTENTS TANK USE W Ia.MOTOR VEHICLE FUELING O Ib.MARiNAFUELING 0 Ic.AVIATION FUELING 43Y ❑ 3.CHEMICAL PRODUCT SFORAGE 0 4.HAZARDOUS WASTEOndW.CW Odl O S.EMERGENCY GENERATOR FUEL IHK 135281 NOI ❑ 6.OTHER GENERATOR FUEL 0 95.UNKNOWN 0 99.OTHER(S ci ): J3% CONTENTS PETROLEUM. 0 Is.REGULAR UNLEADED 0 Ic,MIDGRADEUNLEADED O IN.PREMIUM UNLEADED .uu IN 3.DIESEL 0 5.JET FUEL 0 6.AVIATION GAS 0 S.PETROLEUM BLEND FUEL 0 Q.OTHER PETROLEUM 5 ci JAOa NON-PETROLEUM 07.USED OIL 010.ETHANOL ❑ 11.OTHER NON-PETROLEUMS iPo: 440E IV. TANK CONSTRUCTION TYPE OF TANK 0 L SINGLE WALL CR 2.DOUBLE W ILL 0 95.UNKNOWN 443 PRIMARY CONTAINMENT M I.STEEL 0 3.FIBERGLASS 0 6.INTERNAL BLADDER a4a 0 ].SFEEL+INTERNAL LINING 0 95,UNKNOWN 0 99.OTHER 5 i : Naa SECONDARYCONTAINMENT ❑ LSTEEL 3.FIBERGLASS ❑ 6.EXTERIOR MEM BRA 147117 R ❑ ].IACKETED Jas 0 90.NONE 0 95.UNKNOWN 099.OTHER 5 aux OVERFILL PREVEN TION LAUDIBLE&VISUAL ALARMS C1 2.BALL FLOAT m 3,FILL,TUBE SHUT-OFF VALVE 452. 0 4.TANK SIMS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRuc-noN DI.SINGLE-WALLED 2.DOUBLE-WALLED 093.OTHER a(n SYSTEM TYPE. IN I.PRESSURE 0 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION 4.SAFE SUCTION D3 CCRg26lHaX511 45N PRIMARY CONTAINMENT 0 L STEEL M 4.FIBERGLASS 0i FLEXIBLE U I0.RIGID PLASTIC +M 0 %.NONE 0 95.UNKNOWN ❑ 99.OTNER(S cif'): u.4. SECONDARY CONTAINMENT 0 I.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE 0 10.RIGID PLASTIC 4646 0 90.NONE 0 95.UNKNOWN 0 99.OTHER($ ). 414 PIPINGMJRBING COIN FAI N'M FN ISUMP T YVL IN LSINGLE WALL, 02.DOUBLE WALL 090.NONE +(Ad V1.VENT,VAPOR RECOVERY(VR)AND /FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT OI.STEEL 4.FIBERGLASS IO.RIGID PLASTIC U 90.NONE 0 99.OTHER(Specify) 4ti4e 461eI VEN SECONDARY CONTAINMENT ❑ I.STEEL 0 4.FIBERGLASS 0 10.RIGID PLASTIC 0 90.NONE M 99.OTHER(Specify) awf 464n VR PRIMARY CONTAINMENT ❑ I.STEEL 04.FIBERGLASS 0 IO.RIGIDPLASTIC W 90.NONE 099.0THFR(SPmify) 4Ma J64 I VR SECONDARY CONTAINMENT I.STEEL 0 4.FIBERGLASS 0 10.RIGID PLASTIC 29 90.NONE 99.OTHER(Spccify) 4Mh JNh I VENT PIPING TRANSITION SUMP TYPE 1.SINGLE WALL Q 2.DOUBLE WALL 90.NONE RISER PRIMARY CONTAINMENT IN I.STEEL U 4.FIBERGLASS Lj 10.RIGIDPLASTIC UR 90.NONE LI 99.OTHER(Sp i y) 4MJ RISER SECONDARY CONTAINMENT I.STEEL 4.FIBERGLASS M 10.RIGID PLASTIC N 90,NONE 99.OTHER(Specify) 4t l FILL COMPONENTS INSTALLED EX L SPILL BUCKET 3.STRIKER PLATFIBOTTOM PROTECTOR 4.CONUMNMENTSUMP 451eo VIL..UNDER DISPENSER.CONTAINMENT:(UDC) CONSTRUCTION TYPE ® I.SINGLE WALL 0 2.DOUBLE WALL 0 3 NO DISPENSERS 0 90.NONE +6°' • CONSTRUCTION MA FERIAE C9 LSTEEL 04.FIBERGLASS 01O RIGIDPLASGC ❑ 99.OTHE'RfS eci 1 46N< �.ue. Vill. CORROSION PROTECTION STEEL COMPONENT PROTECTION 0 2.SACRIFICIAL ANODES) 0 J IMPRESSED CURRENT M 6.ISOLATION a4A LY. APPLICANT SIGNATURE �"Y' CERTIFICATION: I certify that this GST system is compatible with the hazardous substance stored and that the informelian provided herein is trop accurate. and in NII compliance with kaml muirements. am APPLICANT SIGNATURE. 9/J_ DATE 3/23/09 ar2 APPLICANT NAME(print) Mike Ellasou n1. APPLICANT TITLE Cardlock Manager UPCF UST-B-1/2 Re,(122007)