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S � 3 OPERATING PERMIT APPLICATION-TANK INFORMATION(One fnrm per UST) KERN COUNTY ENVIRONMENTAL.HF.AI.:rH SERVICES UNIFIED PROGRAM CONSOLIDATED FORM DFPARTMFNf UNDKRGROUNO STORAGE TANK 2700 M STREET,SURE-300 BAKERSFIELD,CA 93301 (661)962-8700 I=(661)862-870) (one page per imlk) Page I_of4 TYPE OF ACTION (Chak one nem only. Foran USI permanent c1cmirc or r=c,r%L eompletc only this sums and Sections 1,11,IB,N,end DC below) 00 ® I.NEW PERMIT ❑ 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION 6.TEMPORARY UST CLOSURE 7.UST PERMANENT CJDSURF,ON SITE ❑ R.LIST REMOVAL DATE UST PERMANENTLY CI ON 4"s 1 DATE IDDSTINO(1ST DISCOVERED) 4Jae 1. FACILITY INFORMATION FACU,TTY ID 8(,(gency Use Only) BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) Love's Travel Stop 11538 PRO 613 r? BUSINESS SEIE ADDRESSIm ITIM 15250 Noah Thomton Road Lad)Y II.TANK DESCRIPTION TANK M# 1 4n TANK MANUFACTURER 413 TANK LVNF1ct1RATTraN: THIS TANK is a< KerseS N 1.ASfAND-ALONE TANK ❑2.ONE IN A(Ob1PARTMEtrED UNIT. we ID..,m mus ea DATE UST SYSTEM INS FAI I ED 411 TANK CAPACITY IN GALLONS 4J6 NUMBER OF COMPARTMENTS DJ THE UNIT 437 912013 30000 1 ID.TANK USE AND CONTENTS TANK USE ® 1a MOTORVERJCL.EFUEIING ❑ Ib.MARINANAFUF.LM ❑ IC.AVIATIONFUELING 414 ❑ 3.CHEMICAL PRODUCE STORAGE ❑ 4.HAZARDOUS WASTE(1 1 the ad) ❑ 5.EMERGENCY GENERATOR FUEL.JIM 1212115(g1 ❑ 6,OTHER GENERATOR FUJI. ❑ 95.UNKNOWN ❑ 99.OII*2(Spairyk .3A CONTENTS PETROLEUM: N Is.REGULAR UNLEADED ❑ le.M1DCRADE UNLEADED ❑ Ib.PRFMRIMUNLFAIFD 449 ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.Ph MOW:UM BLEND FUEL ❑ 9.OTHER PETROLEUM i : 449. NON-PETROLEUM p 7.USED oA ❑ I0.ETHANOL 11.OTHFH NON-PETROLEUM 4406 IV. TANK CONSTRUCTION TYPEOFTANK1.SINGLE WAIL ® 2.00UBLE WALL 95.UNKNOWN u1 PRIMARY CONTAINMENT ❑ I.STEEL C9 FIBERGLASS ❑ 6.INIPRNAL BLADDER 4H ❑ 7.STFE,+INTERNALIJNTNG ❑ 95.UNKNOWN ❑ 99.OTHER 4N4 SECONDARY CONTAINMENT ff 1,Srm W 3.FIBERGLASS ❑ 6.E)rTTIFUOR MEMBT AXE LINER ❑ 7.JACKMW 44 ❑ 90.NONE ❑ 95.UMMWN 1399.arm 051 OVEEHL PREVENTION la 1.AUDIBLE R VISUAL ALARMS 2-RALL FLOAT Q9 3.FILL TUBE SHUT-OFF VALVE .ss. ❑ 4.TANKMEETS REQUIREMENTS FOR MOWI ONFROMOVBRF'BL-PREVENTION EWIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PING CONSTRUCTION ❑1.SINGLE WALLE17 N 2.DOUBLE-WAMED ❑99.OrM .60 SYSTEM TYPE I.PRTiSSl7RE ❑ 2.GRAVITY ❑ 3.CONVFNfIONAL STICTION ❑ 4.SAFE SUCTION[z ccs )1 451 PRIlARY CONTAINMENT I.STFII. ® 4.E®FR IS ❑ e.EEICIBLE ID.A" PLASTIC .tis ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTM(Sp ffy). 461r SECONDARY CONTAINMENT T.STFII. 4.FIBERGLASS ❑ &E-7 EGIE c ❑ 10.RIGID PLASTIC 466 ❑ 9R NONE ❑ 95.UNKNOWN ❑ 99.OTHER 464 PWNGMYRBLNE CONTAINMENT SUMP TYPE 0 1.SINGLE WALL ® 2.DDLIEEWAW- 0 90.NONE +641 VI.VENT,YAPOR RE 'OV ERY(VRI AND RLSER/FILL PIPE PIPING CONSTRUCTION VEITPRIMARY CONF2MENT I.STEFI. Q9 I.FIBERGLASS LJ 10.RIGID MASTIC 90.NONE 0 99.OTHER(Sp=fy) 464 e41 VERT SECONDARY CONTAINMENT 0 1.SLFFI:TT. 0 1.FIBERGLASS 0 10.R1GR1 I7A9TLC 0 90.NONE 99 RTI'IO(Spcify) N64f VR PRIMARY CONTAINMENT I.STEEL N {.FIBERGLASS 0 10.RIGID PLASTIC ❑ 90.NONE 0 99,OTHER(Specify) 4Ma l'R SECONDARY CONTAINMENT El L STEEL 0 4.FIBERGLASS 10.RIGID PLASTIC ❑ 90.NONE 0 99.OTHERas ' (Sp¢ify) 169 6411 VENT PIPING TRANSITION SOAP TYPE 0 1.SINGLE WALL 2 DOUBLE WALL 0 9a NONE 46a RISFR PRDIARY CONTAINMENT 29 1.STEED, U 4.FIBERGLASS ❑ 10.RIGID R.ASTIC 0 90.NONE 0 99.OTHER(Sp=fy) 461j RISER SECONDARY CONTAINMENT 13 1.STEEL, 0 4.FIBERGLASS 10.RIGIDPLASTIC ® 90.NONE 0 99.OTHER(Specify) 4a4t 6 E1 FI.L COMPONENTS INSTALLED 13 I.SPILL BUCKET 0 3.STRD VR UNDER DISPENSER CONTAINMENT"C) CONSTRUCTION TYPE O 1.SINGLE WALL 12 2.DOI IFILF.WALL ❑ 3.NO DISPENSERS ❑ 9Q NONE 469. CONSIRUCTLON MATE IAL O I.STNSL N 4.FMMtGLASS O 10.RIGID PLASTIC ❑ 99.OTHER 46Abc VIII- CORROSION PROTECTION STEEL COMPONENT PROTECITON ❑ 2.SACR/ECIALANODE(S) ❑ 4_IMPRESSED CURRENT ® 6.ISOLATION DL APPLICANTSIGNATURE CERTIFICATION: I certify that this UST system is compatible with the hazardous substance stared and that the Infarmntion Provided herelo ante,. sudinfidlem isinctivithicaregairements. APPLICANT SIGNATURE DATE 7/29 2013 cz:) 419. APPLICANT NAME(prW) Kimberly Mi nL APPLICANT TITLE West Coast Environmental Mager 4n UPCF UST-B-VS ReL- )