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UNIFIED PROGRAM CONSOLIDATED FORM f UNDERGROUND STORAGE TANK OPERATING PERMTP APPLICATION-TANK INFORMATION(One form per usT) TYPE OF ACTION (Check one i(cm only. For an UST permanent closure or removal,complete only MIS Section and Sections 1,R,11I,N,and 1X below) (' ao ❑ 1.NEW PERMIT ❑ 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION F �, ❑ b.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ® 8,UST REMOVAL DATE UST PERMANENTLY CLOSED: 43-- I DATE EXISTING UST DISCOVERED: 10/24)2012 yob I, FACILITY INFORMATION FACILITY ID#�(Agency Use Only) ' BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 CALTRANS HighwM 26 Right of We ,State of California BUSINESS SITE ADDRESS 103 CITY Iw N.E.comer of 19107 East Highway 26 Linden (Caltrans Ri t of Way) U.TANK DESCRIPTION TANKIDdUST-1-Linden Q TANK MANUFACTURER 431 TANK CONFIGURATION:THIS TANK IS 414 RHEEM ®1,h STAND-ALONE YANk ❑2.ONE M A COMPARTMUNIT. I. DATE UST SYSTEM INS• A L US Cam Neon ror etch mm ntheunit. TANKCAPAC7 BdOALLONS 436 NUMBER OF COMPARTTS M THE UNIT 4» 1922-1935 A roX,400- allons one HL TANK USE AND CONTENTS TANK USE R9 Ia.MOTOR VEHICLE FUELING ❑ Ib.MARINAFUELINO ❑ 19,AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE U 4.HAZARDOUS WASTE D..I.dea Ma Oil) ❑ S.EMERGENCY GENERATOR FUEL[HSCS25231S(c)) ❑ 6.OTHER GENERATOR FUEL [195.UNKNOWN ❑ 99.OTHER(Spcciy): 439. CONTENTS PETROLEUM: ❑ Is.REGULAR UNLEADED ❑ to MIDGRADE UNLEADED ❑ Ib.PREMIUM UNLEADED 4+0 ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ S.PETROLEUM BLEND FUEL ® 9,OTHER PETROLEUM (specify): Leaded Gasoline 440a NON-PETROLEUM❑ 7.USED OIL ❑ 10.ETHANOL ❑ I(.OTHER NON-PETROLEUM(S i : 44M IV. TANK CONSTRUCTION TYPEOF TANK 19 1.SINGLE WALL ❑ 2-DOUBLE WALL ❑ 95.UNKNOWN PRIMARY CONTAINMENT F9 1.STEEL ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 4M ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ W,OTHER (Specify): 4444 SECONDARY CONTAINMENT ❑ I.STEEL ❑3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7,JACKETED 445 ® %NONE ❑ 95,UNKNOED-WN ❑99.OTHER(S 465a OVERFILL PREVENTION ❑ I•AUDIBLE&VISUAL ALARMS 2.BALL FLOAT ❑ 3,FILL TUBE SHUT-OFF VALVE 451 ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ®1.SINGLE-WALLED ❑2.DOUBLE-WALLED ❑99.OTHER 46o SYSTEMTYPE ❑ I.PRESSURE 0 2-GRAVITY ❑3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[B CCR 2416(•X3)1 453 PRIMARY CONTAINMENT ❑ L STEEL ❑ 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10,RIGID PLASTIC - 464 ® 90:NONE ❑ 95,UNKNOWN ❑ 99,OTHER( ify): 4W SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4,FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGIDPLASTIC 46,b ® 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c PIPING/TURBINE CONTAINMENT SUMP TYPE ❑ I.SINGLE WALL 02.DOUBLE WALL ® 90.NONE 4641 VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT N L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE Ll 99.OTHER(Specify) 4694 46441 VENT SECONDARY CONTAINMENT 0 1.STEEL 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE 0 99.OTHER(Specify) 4Rn VR PRIMARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99,OTHER(Specify) 46gg 4MI) VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC 0 90.NONE ❑ 99.OTHER(Specify) 464" 4Mhl VENT PIPING TRANSITION SUMP TYPE ❑ I.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE 4641 RISER PRIMARY CONTAINMENT ❑ I.STEEL 0 4.FIBERGLASS ❑ 10.RIGID PLASTIC 9 90.NONE ❑ 99.OTHER(Speuy) 4641 4641 RISER SECONDARYCONTAINMENT 0 I.STEEL ❑ 4.FIBERGLASS [110.RIGID PLASTIC ® 90.NONE [399.OTHER(Speciry) 4644 46441 FILL COMPONENTS INSTALLED [II.SPR.LBUCKET ❑ I.STRIKERPLATFIBOTrOMPROTECTOR ❑ 4.CONTAINMENT SUMP 4s1.< VIL UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ❑ 1.SINGLE WALL ❑ 2,DOUBLE WALL ❑ 3.NO DISPENSERS M 90,NONE 46% CONSTRUCTION MATERIAL ❑ 1.STEEL ❑ 4,FIBERGLASS ❑ 10.RIGID PLASTIC ® 99.OTHER(Spmiry)none owb VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION El 2.SACRIFICIAL ANODE(S) ❑ 4.MTRESSED CURRENT ❑ 6.ISOLATION 448' DI. APPLICANT SIGNATURE CERTIFICATION: I urtify that this UST system is compatible with the hazardous substance stored and that the information provided herein is truq accurate, and in full compliance with legal requirements. APPLICANT SIGNATURE,,g..,-'_., "0 10/14/2014 970 UPCF UST-B-1/3 Rev.(122007)