BILLING_2010-2015 - Laserfiche WebLink

Home Browse Search

ED PROGRAM CONSOLIDATED FOR UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION (one farm per UST) TYPE OF ACTION (Check one item only. For a UST closure or removal,complete only this section and Sections 1,11,111,N,and IX below) 430. ❑ 1.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: 430.. 1 DATE EXISTING UST DISCOVERED: 4301,. I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) - Q p 0 _ U BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3. 7-Eleven#32190 BUSINESS SITE ADDRESS 103. CITY 100. 4943 S. State Route 99 Stockton II. TANK DESCRIPTION TANK ID# 432. TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434. 003 XCLX23 ® LASTAND-ALONE TANK Complete one page toreach ❑ 2.ONE IN A COMPARTMENTED UNIT compartment in the-nit. DATE UST SYSTEM INSTALLFC 435. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS IN THE UNIT 437. 6/2003 (o Lb �3 10,000 III. TANK USE AND CONTENTS TANK USE 10 la.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ 1c.AVIATION FUELING 439. ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil ❑ 5.EMERGENCY GENERATOR FUEL DISC§25281.5(,)1 _ ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 439.. CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED ❑ IC_.MIDGRADE UNLEADED ® Ib.PREMIUM UNLEADED 440. ❑ 3.DIESEL ❑ 5.JEr FUEL ❑ 6.AVIATION GAS ❑ S.PETROLEUM BLEND FUEL ❑ 9 OTHER PETROLEUM(Specify): 440 NON-PErkonuml 7USED OIL ❑ 10.ETHANOL ❑ I I.OTHER NON-PETROLEUM(Specify): 440b. IV. TANK CONSTRUCTION TYPE OF TANK ❑ L SINGLE WALL ® 2.DOUBLE WALL ❑ 95.UNKNOWN 443. PRIMARY CONTAINMENT ❑ I.STEEL ® 3 FlBERGLASS ❑ 6.INTERNAL BLADDER 444' ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 444a. ..............................._.....-....................-.-.-______._ _______________-.--.-....................-.-.______ SECONDARY CONTAINMENT ❑ 1.STEEL ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445. ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specify): 445.. ........-. __....... ..... ........... ................ . ......... ..-......--- _________-______ OVERFB-L PREVENTION ® LAUDIBLE&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 ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 99.OTHER 460. _S_YSTEM TYPE ® 1.PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION [1 4.SAFE SUCTION I'-3 CCR§2636(a)(3)1 456. PRIMARY CONTAINMENT ❑ 1.STEEL ❑ 4 FIBERGLASS ® 8 FLEXIBLE ❑ 10.RIGID PLASTIC 464 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464a. SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ® 8.FLEXIBLE ❑ 10.RIGID PLASTIC 4641. _❑ 90.NONE_ ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): _ _._-..... ..........____-. ffING/TURBINE CONTAINMENT SUMP TYPE ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE VI. VENT,VAPOR RECOVERY (VR) AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC [390.NONE ❑ 99.OTHER(Specify). 46ae. ............._ 4 I_. ___ .... f. VENT SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 44M . .......... ............... _.___ ......................... ------- VR PRIMARY CONTAINMENT ❑ 1 STEEL ® 4.FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 90.NONE ❑ 99 OTHER(Specify): 4�g. VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4 FlBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99 OTHER(Specify): 446h1 _..___ ............... ......... __-__-.- _..___. . -............ _..__ ......... ..........-._._ VENT PllaING TRANSITION SUMP TYPE ® L SINGLE WALL ❑ 2 DOUBLE WALL ❑ 90.NONE 464` _-_.--..- .-_______ _............... .-_____ _____ -.-. .... ................. RISER PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): ,464�I ________. ____.-.-______ __.___ ____ _-.__..._.-_....................................... RISER SECONDARY CONTAINMENT ❑ I STEEL ❑ 4 FIBERGLASS ❑ 10 RIGID PLASTIC M 90.NONE ❑ 99 OTHER(Specify): a4Mk. FILL COMPONENTS INSTALLED ® L SPILL BUCKET ® 3.STRIKER PLATFIBOTTOM PROTECTOR ❑ 4.CONTAINMENT SUMP 451 a-c. VII. UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE ® 1 SINGLE WALL ❑ 2 DOUBLE WALL ❑ 3 NO DISPENSERS ❑. 90 NONH` -'� 469a. CONSTRUCTION MATERIAL ❑ 1.STEEL ® 4 FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99 OTHER(Specify) 469b. Pe ;". 469c. VIII. CORROSION PROTECTION '` g STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION 448. IX. APPLICANT SIGNATURE CERTIFICATION: I certify that this UST system is compatible with the hazardous substance stored and that the information provided herein is true, accurate and in full compliance with legal requirements. APPLICANT SIGNATURE T' DATE 470. rL APPLICANT NAME(print) Ian Moorhead 471. APPLICANT TITLE Env. Compliance Mgr. 072' UPCF UST-B Rev.(1712007)-1/2 vvww.unidocs.org