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l �IED PROGRAM CONSOLIDATED FOF <br /> �./ UNDERGROUND STORAGE TANK 'a1 <br /> TYPE OF ACTION (cOPERATheck one Item �yINGpP RMILIST clomire�rAPPLI APem-1,-Plele PLICATION thij ctiTANK INFORMATION (Oneformper UST) <br /> m and Sections 1.11, Ifl.IV and IX below) 430 <br /> 0 I.NEW PERMIT 0 3.RENEWAL PERMITEl ® 5.CHANGE OF INFORMATION <br /> 6.TEMPORARY UST CLOSURE 7.UST PERMANENT CLOSURE ON SITE8.UST REMOVAL <br /> DATE UST PERMANENTLY CLOSED: 4504 DATE EXISTING UST DISCOVERED: 4506 <br /> FACILITY[DO(Agency Ux Only/ I. FACILITY INFORMATION <br /> BUS[ ilify Name ar DBA-Doing Business As) 5 <br /> hell/Tesoro 6815 <br /> BU RESS )m CITY la <br /> 13975 E. Hiwa 88 Lockeford <br /> II. TANK DESCRIPTION <br /> TANK IDM 432 TANK MANUFACTURER u5 <br /> _ TANK CONFIGURATION:THIS TANK IS 454 <br /> #7 6�✓� STIP ® I A STAND-ALONE TANK Canpkior epyestc W <br /> DATE UST SYSTEM INSTALLED 455 TANK CAP2.B IN A COMPARTMENTED UNIT wwmaaa u ft uw. <br /> ACITY IN GALLONS 4M NUMBER OF COMPARTMENTS IN THE UNIT 45s. <br /> 1990 10,000 <br /> 1 <br /> III. TANK USE AND CONTENTS <br /> TANK USE 0 In MOTOR VEHICLE FUELING 0 I b.MARINA FUELING 0 Ic.AVIATION FUELING u9. <br /> 0 3.CHEMICAL PRODUCT STORAGE 0 4 HAZARDOUS WASTE(Tmi ause400) 0 S.EMERGENCY GENERATOR FUEL(NSC Imvl 5(c)J <br /> 0 6.OTHER GENERATOR FUEL 0 95.UNKNOWN099.OTHERS i ): 094 <br /> CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED Ic.MIDGRADE UNLEADED 0 It.PREMIUM UNLEADED 4+0 <br /> 0 3.DIESEL 0 5.JET FUEL D 6.AVIATION GAS <br /> 0 8.PETROLEUM BLEND FUEL 0 9.OTHER PETROLEUM( i ): 44N <br /> NON-PETROLEUM:E3 7.USE60 L 10.EINANOL <br /> (] 11.OTHER NON-PETROLEUM(Specify): <br /> s4ob. <br /> W. TANK CONSTRUCTION <br /> TYPE OF TANK _ 0 1 SINGLE WALL 99 2.DOUBLE WALL 0 95.UNKNOWN u3 <br /> PRIMARY CONTAINMENT ® I.STEEL 0 3.FIBERGLASS D 6.INTERNAL BLADDER 444 <br /> 0 7.STEEL-INTERNAL LINING 0 95.UNKNOWN 0 99.OTHER(S i p 444a <br /> SECONDARY CONTAINMENT 0 1.STEEL 0 3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER 0 7,JACKETED us <br /> 0 90.NONE 0 95.UNKNOWN ❑99.OTHER_(Specify). "M <br /> OVERFILL PREVENTION 0 I.AUDIBLE&VISUAL ALARMS 0 2.BALL FLOAT 0 3.FILL TUBE SHUT-OFF VALVE 452 <br /> 4 TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT <br /> V. PRODUCT/WASTE PIPING CONSTRUCTION <br /> PIPING CONSTRUCTION 0 I.SINGLE WALL_ 0 2.DOUBLE WALL 0 99.OTHER 460 <br /> SYSTEM TYPE 19 1.PRESSURE 0 2.GRAVITY 0 3.CONVENTIONAL SUCTION D 4.SAFE SUCTION in CCR JW6(. 3) rn. <br /> PRIMARY CONTAINMENT 0 I.STEEL ® 4.FIBERGLASS 0 8.FLEXIBLE 0 10.RIGID PLASTIC 466 <br /> 0 90.NONE 0 95.UNKNOWN 0 99.OTHER(Speci Po)_ aaa <br /> SECONDARY CONTAINMENT 0 1.STEEL ® 4.FIBERGLASS 0 S.FLEXIBLE 0 10.RIGID PLASTIC 46+6 <br /> 0 90.NONE 0_95.UNKNOWN 0 99.OTHER(Specify). 4ac <br /> PIPING/TURHINE CONTAINMENT SUMP TYPE 0 I.SINGLE WALL 0 2.DOUBLE WALL 0 90.NONE - 4676 <br /> VI. VENT, VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION <br /> VENT PRIMARY CONTAINMENT ® 1 STEEL 0 4.FIBERGLASS 0 10,RIGID PLASTIC 0 90.NONE D 99.OTHER(Specify): 4� <br /> VENT SECONDARY CONTAINMENT 0 I.STEEL 0 4.FIBERGLASS D 10.RIGID PLASTIC 0 90.NONEOar <br /> 0 99.OTHER(Specify): 4an <br /> VR PRIMARY CONTAINMENT0 I.STEEL 0 4.FIBERGLASS ❑ ID.RIGID PLASTIC 0 90.NONE 0 99.OTHER(Specify) 46ft <br /> VR SECONDARY CONTAINMENT 0 1.STEEL 0 4.FIBERGLASS 0 10.RIGID PLASTIC ® 90.NONE 0 99 OTHER(Specify): as nl <br /> VENT PIPING TRANSITION SUMP TYPE D 1.SINGLE WALL D 2.DOUBLE WALL IN 90,NONE 464, <br /> RISER PRIMARY CONTAINMENT 0 I.STEEL 0 4.FIBERGLASS 0 10.RIGID PLASTIC D 90 NONE 0 99.OTHER(Specify): 464�1 <br /> RISER SECONDARY CONTAINMENT 0 1.STEEL 0 4.FIBERGLASS 0 10.RIGID PLASTIC 0 90.NONE 099.OTHER(Specify): Oak_ <br /> _ 4at). <br /> FILL COMPONENTS INSTALLED ® L SPILL BUCKET ® 3.STRIKER PLA I E/W FrOM PROTECTOR D 4.CONTAINMENT SUMP 4541 <br /> VII. UNDER DISPENSER CONTAINMENT(UDC <br /> CONSTRUCTION TYPE ® 1.SINGLE WALL _ 0 2 DOUBLE WALL_ 0 3.NO DISPENSERS 0 90.NONE 4444 <br /> CONSTRUCTION MATERIAL ® I.STEEL ❑ 4.FIBERGLASS 0 10 RIGID PLASTIC 0 99.OTHER(Specify) 4aa6%_ <br /> 9s <br /> VIII. CORROSION PROTECTION <br /> STEEL COMPONENT PROTECTION 0 2.SACRIFICIAL ANODE(S) 0 4.IMPRESSED CURRENT 0 6.ISOLATION as <br /> OL APPLICANT SIGNATURE <br /> CERTIFICATION: I certify that this UST system is compatible with the hacardous substance stored and that the information provided herein is true, <br /> accurate,and in full combutte with I al re uirements. <br /> APPLICANT SIGNATURE DATE 1 10 <br /> APPLICANT <br /> 4m <br /> APPLICANT NAME(print) Sandy Ed ands 411 APPLICANT TITLE Environmental Compliance "r <br /> UPCF LIST-B Rev.(17/2007)-1/2 www.umdocs.org <br />