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is ,PMFIED PROGRAM CONSOLIDATED F ' G� II UNDERGROUND STORAGE TANK �Qh� �) x OPERATING PERMIT APPLICATION-TANK INFORMATIO (one form per UST) TYPE OF ACTION (Check one item only. For an UST permanent closure or removal,complete only this section and Sections I,II,III,IV,and IX below) 430 ® I.NEW PERMIT ❑ 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ® S.UST REMOVAL DATE UST PERMANENTLY CLOSED: 43ca DATE EXISTING UST DISCOVERED: 4306 I. FACILITY INFORMATION FACILITY IDH(Agency Use OnlyI _ I BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) Wal eens 3 BUSINESS SITE ADDRESS 103 CITY Northeast corner of Farmington Rd and E104 Mari osa Rd Stockton II.TANK DESCRIPTION TANK ID H Unknown 432 TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK IS Unknown 410 Unk ®l.A STAND-ALONE TANK /�T ❑2.ONE M A COMPARTMENTED UNIT, DATE USTSYS 1 tMIM 435 TANK CAPACITY IN NU GALLONS q36 Com lMe one aeFor eachwmertmentinshetnit. Unknown MBER OF COMPARTMENTS IN THE UNIT 432 1000 Unknown TANK USE ® Ia.MOTOR VEHICLE FUELINIII.TANK USE AND CONTENTS G ❑ Ib.MARINA FUELING ❑ 3.CHEMICAL PRODUCT STORAGE El lc.AVIATION FUELING 439 ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ❑ S.EMERGENCY GENERATOR FUEL IHSC§2521 ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 439a CONTENTS PETROLEUM: ❑ In REGULAR UNLEADED ❑ Ic.IvIIDGRADE UNLEADED ❑ lb.PREMIUM UNLEADED 440 ® 3 DIESEL ❑ 5.JET FUEL ❑ S.PETROLEUM BLEND FUEL ❑ 6.AVIATION GAS NON-PETROLEUM:❑ 7.USED OIL 9'OTHER PETROLEUM S eci 440e ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify 4406 IV. TANK CONSTRUCTION TYPE OF TANK ® 1.SINGLE WALL ❑ 2.DOUBLE WALL 1] 95.UNKNOWN PRPAARY CONTAINMENT IN I.STEEL ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 443 ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER 444 SECONDARY COMAINMENT ❑ I.STEEL ❑3.FIBERGLASS (Sped ): 444a ® 90.NONE ❑ 6.EXTERIOR MEIvIDRANE LINER ❑ 7.IACKETED 445 OVERFILL PREVENTION 95.UNKNOWN ❑99.OTHER(Specify ❑ 1.AUDBLE&VISUAL ALARMS ❑ 2.BALL FLOAT 4451 ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFI O PREIVEN IT ON EQ PMENT�� 452 V. PRODUCT/WASTE PD'ING CONSTRUCTION PIPING CONSTRUCTION ® LSINGLE-WALLED ❑2.DOUBLE-WALLED SYSTEM TYPE � 1 PRESSURE ❑99.OTHER 460 PRIMARY CONTAINMENT ❑ 2.GRAVITY ❑ 3.CONVEMIONAL SUCTION ❑ 4.SAFE SUCTION 123 CCR§2636(a)(3)] 458 ❑ 90.ONE q.FB3ERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464 SECONDARY CONTAINMENT ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464a ❑ 1.STEEL ❑ q.F®ERGLASS Us.FLEXIBLE ® 90.NONE ❑ 95.UNKNOWN ❑ 10.RIGID PLASTIC 4641, PtPMGITURBRJE CONTAINMEMSUMP TYPE ❑ 99.OTHER(Specify): 464c ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90 NONE VI.VENT,VAPOR RECOVERY 464d vENT PR MARY coNTAINMENT ) D RISER/ PIPE PIPING CONSTRUCTION ❑ I.STEEL ❑ q.FBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify) 4641 VENT SECONDARY CONTAINMENT ❑ 1.STEEL ❑ q.FIBERGLASS 464el ❑ 10.RIGID PLASTIC ® 90.NONE 99.OTHER(Specify) 464( VR PRIMARY CONTAINMENT ❑ I.STEEL ❑ 4,FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE 1] 99,OTHERS 46 VR SECONDARY CONTAINMENT (Specify) 8 ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify) 464g I VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL 464hl RISER PRIMARY CONTAINMENT ❑ 1.STEEL ❑ 4,FIBERGLASS ® 90.NONE 464i. ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify) 464j RISER SECONDARY CONTAINMENT ❑ L STEEL ❑ 4,FIBERGLASS ❑ 10.RIGID PLASTIC ( p �) 454 1 ® 90.NONE ❑ 99.OTHER S eci 464k FILL CObIDONENTS.INSTALLED ❑ L SPILL BUCKET ❑ 3.STRIKER PLATE/BOTTOM PROTECTOR ❑ 4,CONTAINMENT SOME g564k� VII. UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ❑ L SINGLE WALL ❑ 2.DOUBLE WALL CONSTRUCTION MATERIAL ❑ I.STEEL L14,FIBERGLASS ❑ I0.RIGID PLASTIC El 3.NO DISPENSERS EI 90.NONE 9 ❑ 99.OTHER(Specify °6969b-c VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION 2.SACK FICIAL ANODES) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION 448, CERTIFICATION: I rtify I is T cyst co ible W"n me hazardousSubstance stnorred and that the information provided herein is true,accurate, nd in full co it le 11 airements. APPLICANTSIGNATURE DATE 10/20/2011 470 APPLICANT NAME(print) Frank Poss 471. APPLICANT TITLE Department Manager 472. UPCF UST-B-1/2 Rev.(12/2007)