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OPERATING PERMIT APPLICATION-TANK INFORMATION(one form per uST) KERN COUNTY ENVIRONMENTAL HEALTH SERVICES UNITED PROGRAM CONSOLIDATED FORM DEPARTMENT UNDERGROUND STORAGE TANK 2700 M STREET,SUITE 300 BAKERSFIELD.CA 93301 (66])8624700 Fax(661)962-9701 (one page per tank) Page iof4 TYPE OF ACTION (Chock ane item only. For an UST permanent closure Or«mo.al,complete only NiS Section and Sections I,11,H],IV,and rX below) ^+� ® 1.NEW PERMIT ❑ 3.RENEWAL PERMIT ❑ 5.CHANGE OF QNFORMA'noN ❑ C TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DATE UST PERMANEN FLY CLOSED 4TO DATE EXISTING UST DISCOVERED: 43ab L FACILITY INFORMATION FACILITY ID 0(Agency Um 0*) BUSINESS NAME(Sant as FACILITY NAME a DBA-Doing Business As) 3 Love's Travel Stop 5538 FRO BUSINESS SITE ADDRESSNorthrm CITY t°+ 15250 NoThornton Road Lodi W TANK DESCRIPTION TANK I1)02 432 TANK MANUFACTURER UI TANK CUIMGURATION:THIS TANKS +34 Xerxes ❑LASTA A1DNETANK O ®2.ONE IN A omeARIME.M'ID UNn. Gnn am witWuO rmwmove haaude DATE UST SYSTEM N ALLED Us TANK CAPACITY IN GALLONS 416 NUMBER OF COMPARTMENTS IN THE UNIT 451 9/2013 12000 2 AI.TANK USE AND CONTENTS TANK USE ® 1a MOTOR VEHICLE FUELING ❑ 1b.MARINA FUELING ❑ Ic AVIATION FUELING Oc 03.CNETICALPRODUCTS1U%tAGE 04.HAZARDOUS WASTEtt LM U qb [35.EMERGENCY OLMATOR FUEL roXp5m 5(c)] ❑ 6.0THERGFNEItATORFIIE. ❑95.UNKNOWN 0 99.0num A154 CONTENTS PETROLEUM: O IcMULAR UNLEADED 0 Ia MIDGRADE UNLEADED 0 M.PREM[UNIDNLEADm 440 10 3,IHF2t4'I. 0 5.JET FUEL 0 6.AVIATION GAS 0 S.PETROLEUM BLEND FUEL N 9.OTHERPETROLEUM : Up to 5%Siodi99el 4q, NON-PE7ROLEUM:0 7.USED OI, 0 10.ETHANOL. 0 11.OTHEIR NON-PETROLEUM 4406 IV. TANK CONSTRUCTION TYPEOFTANK 01.SINGLE WAIL. ® 2.DOUBLE WALL 095.UNKNOWN ul PRIMARY CONTAINMENT 01.57FF1. ® 3.PBFRGLASS 6.INTERNAL BLADDER 4u 07.STEEL+INTERNAL LINING 095.UNKNOWN 099.0THER ): a4M SECONDARY CONTAINMENT 01.STEEL ®3.FIBFRGIASS 06.EXTERIOR MEMBRANE LINER 07.3ACKETFD M5 0 90.NONE 0 95.UNKNOWN 0 99.OTHER us. OVFRFULPREVENTION 0 I.AUDIBLE&VISUAL ALARMS ❑ 1BALLFLOAT N 3.FILL TUBE SHUT-OFF VALVE 452. 0 4,TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVFRFu.L PREVENTION EQuL mwr V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING 6TSTRUCTION ❑1.SINGLE-WALLED ®2.DOUBL&WALLED 0 99.OTHER 4w SYSTEM 1'YFE CA I.PRESSURE 0 2.GRAVITY 0 3.CONVENTIONAL WCTION 4.SAFE SUCn0N r4 ca 453 PRIMARY CONTAINMENT 0 1.STEEL M 4.FIBERGLASS 0 8.FLEXIBLE 0 10.RIGID PLASTIC 4b4 0 90,NONE 0 95,UNKNOWN 0 99.0THER( fo MM SECONDARY CONTADMENT 0 1.STEEL C1 4.FIBERGLASS U I.FLEXIBLE 10.RIGIDPLASTIC 4516 0 90,NONE 0 95.UNKNOWN 0 99.OTrER s ify: 444e PIPING/TURBINE CONTAINMENT SUMP TYPE 0 1.SINGLE.WALL C§ 2.DOUBLE WALL 0 90.NONE 45u VL VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAI0MENT U LMEEI. N 4.FIBERGLASS 13 TO.RIGOPLASTIC In 90.NONB 0 W.OTHER(SpeGfy) 454e 51e1 VENT SECONDARY CONTAINMENT i.StF>;L 10 4.F18FRGIASS 0 10.N1G1DPVSUC 0 90.NONE 99.OTHER(Specify) Our VR PRIMARY CONTAINMENT L3 1,STEEL. 0 4.FIBERGLASS 0 1O.R1GW FIASTIC 1190.NONE El 99.amm(Speofy) +boa VR SECONDARY ODNTAIRMNr 0 1.I= 0 4,FIBERGLASS 10.RIGID PLASTIC 13 90.NONE D 99.OTHER ftecify) 400 M461 VENT P94NG TRANSmON SUMP TYPE M 2-DOUBLE WAIL. El 90.NONE Ise RIVER PRIMARY CONTAINMENT 0 I.STEEL 0 4.FIBERGLASS 0 10.117®PLASTIC u ".NONE u 99.OTHFA(Speeifyl 464 RISER SECONDARY(ONTAI ME NT 0 1.STEEL 0 4.FIBERGLASS 10,RIGID PLASTIC IN %NOW Ll 99.OTHER(Sp.*) +546 46 E FILL(-'OtdPONFNIS INSTALLED I.SPLLL BIIIXET JR35TIUKERPIATEMarrOMPROTECTOR 4.CANTAI046NT SOME 4514.r VIL UNDER DISPENSER CONTAINMENT(UDC) - CONSTRUCTION TYPE 0 L SINGLE WALL 19 2.DOUBLE WALL 0 3.NO DISPENSERS 0 90.NONE 4N). ODNSTROClION MATERIAL 0 1.STEP- ® 4.FIBERGLASS 10.RIGID PLASTIC 0 99.OTTER(. ) 4b9bm VIA. CORROSION PROTECTION SrEa CO61FONFNT PROTECTION 02.SACRIFICIAL ANODE(S) 04.WORESISPDCImRENT ®6.ISOLATION UL APPLICANT SIGNATURE ;, CERTIFICATION: i certify that this UST system Is compatible with the hazardous substance Stewed and Rot the luformatim provided beide Is tevnle, I nd ie fu 4010 ianee with 1 r -remeRW APPLICANT SIGNATURE - DATE 7/29/2013 470' APPLICANT NAME(prim) Kimberly ht APPLICANT TITLE West Coast Environmental Mana 4M UPCF UST-11-I/2 Rev.(122007)