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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK Q OPERATING PERMIT APPLICATION-TANK INFORMATION(one form pe UST) TYPE OF ACTION (Check one item only. For an UST permanent closure or removai,complete only this section and Sections I,11,111,IV,and IX below) 43o ❑ 1.NEW PERMIT ® 3.RENEWAL PERMIT ❑ S.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE-ON SITE ❑ 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 4J0d IDATE EXISTING UST DISCOVERED: 430b 1. FACILITY INFORMATION FACILITY ID 0(Agency Use Only) _ t BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 BIINLSS SCIEADDRESS. 103 CITY UU��..77 C� PM1da JJ tt Stockton 101 II.TANK DESCRIPTION TANK ID ff 432 TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK IS TA0508144 Xerxes j4�GJpr�I.A STAND-ALONE TANK 434 LJ L.ONE M A COMPARTMENTED UNIT. DA TE US"L$Y$TEM INN I ALLED 4J5 Com neon' of«.hlmi tinmeunil. .199y�t$$ TANK CAPACffY M GALLONS <16 NUMBER OF COMPARTMENTS IN THE UNIT 437 8,000 2 111.TANK USE AND CONTENTS TANK USE W la.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ Ic.AVIATION FUELING 439 tl 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Leludes Uud Oil ❑ 5.EMERGENCY GENERATOR FUEL[HSC§n281.5(c)) 6.OTHER GENERATOR FUEL [195.UNKNOWN ❑ 99.0THER(S ecify): 4394 CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED ❑ IC.MIDGRADE UNLEADED ® .I6.PREMIUM UNLEADED 440 ❑ 3.DIESEL ❑ 5.JET FUEL [] 6AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM M: 490a NON-PETROLEUM:U 7.USED OIL ❑ 10.ETHANOL ❑ 1I.OTHER NON-PETROLEUM S eci 440b IV. TANK CONSTRUCTION TYPE OF TANK 0-1-SINGLE WALL 00 2.DOUBLE WALL ❑ 95.UNKNOWN PRIMARY CONTAINMENT ❑ LSTEEL3.FIBERGLASS ❑ 6.INTERNAL BLADDER a3 ❑ 7.STEEL+INTERNAL LINING 4M SECONDARY CONTAINMENT ❑ STEEL ❑ 95.UNKNOWN ❑ 99.OTHER (S 'cif 444, �3.FIBERGLASS ❑ (i.EXTERIOR MEMBRANELINER ❑ 7.JACKETED N5 ❑ 90.NONE ❑ 95,UNKNOWN ❑99.OTHER(S 'cif): /454 OVERFILL PREVENTION +p�1 1.AUDIBLE&VISUAL ALARMS 2.BALL FLOAT 3.FILL TUBE SHUT-OFF VALVE LI 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT 452. V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑1.SINGLE-WALLED 112.DOUBLE-WALLED 1199.OTHER SYSTEM TYPE IN L PRESSURE 4W (] 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION 23 CCR§2636(a)(3) 458 PRIMARY CONTAINMENT ❑ I.STEEL W q.FIBERGLASS ❑ e.FLEXIBLE ❑ 10.RIGID PLASTIC 464 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 46ao SECONDARY CONTAINMENT ❑ 1.STEEL ®® 4.FIBERGLASS ❑ B.FI C 1:1 E !::Flo RIGID PLASTIC 4646 ❑ 90.NONE [) 95.UNKNOWN ❑ 99.OTHER(SoP6N: 4", PIPING/TURBINE CONTAINMENT SUMP TYPE I.SING]Elm ALL U.DOUBLE WALL L1 90.NONE VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION 46 d VENT PRIMARY CONTAINMENT Y, I.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE 99.OTHER(Specify) 464' VENT SECONDARY CONTAINMENT U I.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC 90.NONE 461,1 ❑ 99.OTHER(Specify) 464f VR PRIMARY CONTAINMENT 1.STEEL ❑ 4.FIBERGLASS ❑ IO.RIGIDPLASTIC U W.NONE ❑ 99.OTHER(Spmify) 464g VR SECONDARY CONTAINMENT C1 1.STEEL ❑ q,FIBERGLASS 10.RIGID PLASTIC 90.NONE 460 1 ❑ 99,OTHER(Specify) 464h VENT PIPING TRANSITION SUMP TYPE 1.SINGLE WALL 2.DOUBLE WALL 4MhI RISER PRIMARY CONTAINMENT LSTEEL 4.FIBERGLASS ❑ 90.NONE 4yti ❑ 10.RIGID PLASTIC 90.NONE 99.OTHER(Specify) gbgj RISER SECONDARY CONTAINMENT ,; 1.STEEL 4.FIBERG4A55 U 10.RIGID PLASTIC N 90.N0NE99.OTHER(Specify) g646 FILL COMPONE ON L SPILL BUCKET 119 3.STRIKER PLATE/BOTTOM PROTECTOR Lj 4.CONTAINMENT SUMP g91nk' VII.UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE I.SINGLE WALL ❑ Z.DOUBLE WALL ❑ 3.NO DISPENSERS CONSTRUCTION MATERIAL ❑ 1.STEEL 4.FIBERGLASS ❑ 90.NONE 4694 ❑ 10.RIGID PLASTIC ❑ 99.OTHER(S ecifl 469b< VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2,SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT - ❑ 6.ISOLATION 448. IX. APPLICANT SIGNATURE CERTIFICATION: 1 certify that this UST system is compatible with the hazardous substance stored and that the information provided herein[s_fYue,.pecurate, and in full compl,41oce with le al re i ents. APPLICANT SIGNATURE DATE 870. 10/16/2009 a 4 APPLICANT NAME( rint) en APPLICANT TITLE 472. Jay McILratK Owner UPCF UST-B-1/2 Rev.(12/2007)