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• S 61 <br /> VI-643 <br /> OPERATING PERMIT APPLICATION-TANK INFORMATION(One fmm per UST) <br /> KERN COUNTY ENVIRONMENTAL HEALTH SERVICES UNIFIED PROGRAM MNSOLIDATED FORM <br /> DEPARTMENT UNDERGROUND STORAGETANK <br /> 2700 M STREL•T,SURE 300 <br /> BAKERSFIEID,CA 93301 <br /> (661)062-8700 FU(661)8&2-8701 (om pageper tmk) Pagc .Los 4 <br /> TYPE OFAC ION (Check one item only. Foran UST permanent cloture or removes,c mplet only this uction mid Sections 1,IL,ID,N,and LX below) 00 <br /> I.NEW PERMIT [13.RENEWAL PERMIT ❑ 5.04ANGEOP INFORMATION <br /> 6.TEMPORARYUSTC(ASURP ❑ 7.LIST PERMANENT CLOSURE ON SITE 8.LIST REMOVAL <br /> DATE-UST PERMANENTLY CLOSED: 431a DATE EXISTING UST DISCOVR.REI} `10b <br /> -T 1. FACILITY'AVPORMATION <br /> FACILITY lA P(Aguwy Use Only) <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business AS) IP ' <br /> Love's Travel Stop#538 F Rz) <br /> BUSNESSSDEADDRFSS Int CITY loo <br /> 15250 NoM72romlon Road Lodi <br /> D.TANK DESCRIPTION <br /> TANK ID 0 I 4n TANK MANUFACTURER 433 TANK cDNFIGuRATRvI;TN,sTANR is 434 <br /> XCczes ®L A STAND-ALONBTANK <br /> ❑2.ONE IN AW&WARiMurreD UNIT. <br /> fvetl� Nlhum. <br /> DATE UST SYSTEM INSTALLED os TANK CAPACITY IN GALLONS NUMBER OF COMPARTMENTS N TRE UNIT 437 <br /> 912013 30000 I <br /> UI.TANK USE AND CONTENTS <br /> TANK USE ® I MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ ic.AVLATIONFUELiN(3 m9 <br /> ❑ 3,CHEMICAL PRODUCE STORAGE ❑ 4.HAZARDOUS WASTE 0^a�E--1 W) ❑ 5.EMERGENCY GENERATOR FUEL lllsO lune X=)I <br /> ❑ 6.OTHER GENERATOR FUE1. ❑ 95.UNKNOWN ❑ 99.OIIIM( ): <br /> CONTENTS PETROLEUM D9 Ia REGULAR UNLEADED ❑ Ic-MIDCMADEUNLEADED ❑ It,PREMIUM UNLEADED <br /> ❑ 3.DIESEL. ❑ 5.TET FUEL ❑ S.AVIATION GAS <br /> ❑ 3.PETROLEUM BLEND FUEL ❑ 9.OTBERPETROL EUM i ): M4 <br /> NONPEfROLEUM:0 7.USED OIL D 10.ETHANOL <br /> ❑ 11.OTHER NONTFTROLEUM( - 44M <br /> TV: 'TANK CONSTRUCTION <br /> TYMOFTANK ❑ I.SINGLE WALL NIDOUBLE WALL Q 95.UNKNOWN ul <br /> PRIMARY CONTAINMENT ❑ 1.STEEL ® 3.FIBERGLASS ❑ 6.INTERNAL BLADDER M4 <br /> ❑ T.STEEL+TNTFRNAL L(NTNG ❑ 95.uHniowN ❑99.0 EER 5 ' <br /> W44N <br /> SECONDARYCONTAMENT 0 1.STEEL ®3.FIBERGLASS fl 6.EXN.RIOR MEMBRANE LENER ❑ 3-JAQNT'ED YS <br /> ❑ 90.NONE ❑ 95.LDM40WN ❑99 OTHER ' '): Nye <br /> OVERFILLPREVENTTON I.AUDIBLE&VISUAL ALARMS 2.HALLFLOAT 3-FTI r.TIES SHVT-0FF VALVE 4y. <br /> ❑ 4.TANK MEEFS REQUIREMENTS FOR ECEMPTIONFROM OVERFILL PREVQHTION EQUIPMENT <br /> V. PRODUCT/WASTE PIPING CONSTRUCTION <br /> PING CONSTRUCTION I.SINGLE-WALLED ®2.DOUBLE-WATTLED ❑99.OTHER 40 <br /> SYSTEM TYPE 19 1.PRESSURE ❑ 2.GPAVITY ❑ 3.CONVFXOONAL SUCTION ❑ 4.SAFESUCrIOFTTn CMPsm(.X31I 451 <br /> PRMARY CONTAINMENT ❑ I.STEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGIDPLASDC 44.1 <br /> ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Smiryl 444. <br /> SEC'ONDARYCONTAW)fENT ❑ 1.MTEL N 4,FIBERGLASS ❑ 8.FLOMLC• ❑ 10.RIGIDPLASTIC 444b <br /> ❑ w NONE ❑ 95.UNKNOWN ❑ 09.OTHER 'fy: /Mees <br /> PTINaEFORBINE CONTAINMENT SUMP TYPE ❑ LSINaEWALL N 2.DOUBLE WAIL ❑ 90.NONE 46M <br /> VI.VENT,VAPOR RECOVERY.(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION - <br /> VENTPRIMARYCONTAINMENr I,STPFL ®4.FBFRGLASS ❑ 10.RIGID PLAMC 90.NONE 0 99.OTHER(Sprdfy) 4Her <br /> VENT SECONDARY CONTAINMENT 0 1.STEEL. 9 4.FIBERGLASS 10.RIGID PLASTIC [1 90.NONE 0 99 OTHER(SPmfy) Our <br /> lESO <br /> VR PRIMARY CONTARD4 i 4T I.STEEL ® 4.FIBERGLASS 10.RIGID PLASTIC 0 90.NONE 0 99.OTHER(Sp«.dy) 44N <br /> 61 I <br /> VR SECONDARY CONTAINMENT 1.S'[FFL 19 4.FIBERGLASS ❑ IO.RIGH AASTIC 0 9B.NONE U 99.0'fRFR is�ify) Out <br /> Wbl <br /> VENT PIPING MAItYCTRANSITION ENT TYPE I.SINGLE WALL 2.DOUBLEAST I ❑90.NONE 460. <br /> RISER PRD4ARYCOFTIAIIAQ:NT ® I.STffi. ❑4.FIBERGLASS ❑ 10.RIGID PLASTIC 90.NONE Li 99.01}lQt(SPa"fy) "1 <br /> 1 <br /> RISER SECONDARY CONTAINMENT I.STEEL 4.FIBERGLASS Cl I O.RIGM PLASTIC ® 90.NONE ❑ 99.OTHER(SM*) 464k _ <br /> + kl <br /> FILL COMPONENTS INSTALLED I.SPG.L BUCKET 19 3,STRUOR PLATE180TTOM PROTECTOR 4.CONrANA1FNT SUMP 411.- <br /> W.UNDER DISPENSER CONTAINMENT(UDC) <br /> CONSTRUCTIONTYPE ❑ 1.SINGLEWALL ® 2.DOUBLE.WALL ❑ 3.NODISPENSFRS ❑ 90.NONE 40. <br /> CONSTRUCTION MATERIAL ❑ I.STEEL N 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OMMR(SPmify) 4sn6< <br /> VIIL CORROSIONPROTECnON <br /> STEEL COAB'ONE NTPROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4-IMPRESSED CURRENT 0 6ASOLATION <br /> DL APPLICANT SIGNATURE �. <br /> CERTIFICATION: s certify that this UST system le mmpstiblewiththe hazardous substance stored end chat the information provided herefu Ia conte, <br /> and in full Titnce with I ❑ uirements, <br /> APPLICANT S[GNATURE DATE 7/29/2013 c: a Oro. <br /> APPLICANT NAME(prop) Klmt)efly Mi Y, <br /> n'- APPLICANT TITLE ,Nest Coast Environmental Ma w <br /> ger 4R <br /> UMT UST-B•w R <br />