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r f � LIIED PROGRAM CONSOLIDATED FOR!W. UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION (One form pe?UST) TYPE OF ACTION (Check one item only. For a UST closure or removal,complete only this section and Sections I,II,111,IV,and IX below) 1/j/43 1 / ❑ 1.NEW PERMIT ® 3.RENEWAL PERMIT [15.CHANGE OF INFORMATION L ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 4308. 1 DATE EXISTING UST DISCOVERED: 430b. I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) T7 1 - _ 3 BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) Marigold Shell BUSINESS SITE ADDRESS 103 CITY 104 6131 Pacific Avenue Stockton II. TANK DESCRIPTION TANK ID# 43z TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434. 12'Z3��r f- 1 Owens Corning ® I.A STAND-ALONE TANK Complete one page for each ❑ 2.ONE IN A COMPARTMENTED UNIT compartment in the unit. DATE UST SYSTEM INSTALLED 435. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS IN THE UNIT 437. 12,000 1 III. TANK USE AND CONTENTS TANK USE ® la.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ lc.AVIATION FUELING 439. ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§25281.5(c)] _ _ ❑ 6.OTHER GENERATOR FUEL _ __ _❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 439&. CONTENTS _PETROLEUM: ® la.REGULAR UNLEADED- ❑ lc.MIDGRADE UNLEADED-- ❑ lb.PREMIUM UNLEADED 440 ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS 0 8.PETROLEUM BLEND FUEL ❑ 9.OTHERcify_PETROLEUM(Spe440x. NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL - ❑ 11.OTHER NON-PETROLEUMS ci : 440b. IV. TANK CONSTRUCTION TYPE OF TANK_ ❑_ 1.SINGL_E_W_ALL ® 2.DOUBLE WALL ❑ 95.UNKNOWN_ 443. PRIMARY CONTAINMENT [11.STEEL - ® 3.FIBERGLASS -0 6.INTERNAL BLADDER -- ------- 444 _ [1 7. [37.STEEL+IAL LINING ---[1 95.UUNKNOWN 99.OTHER(Specify): 444a. SECONDARY CONTAINMENT-❑ 1.STEEL- ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specify)_: 445a. OVERFILL PREVENTION ® 1.AUDIBLE&VISUAL ALARMS [12.BALL FLOAT- -W^ ® 3.FILL TUBE SHUT-OFF VALVE 452• ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT /WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 99.OTHER 460. ----._ �... - -_ _ _............_............................ _ --_ SYSTEM-TYPE u ® 1.PRESSURE �2_- RA GVITY-- 0 3.CONVENTIONAL SUCTION [14.SAFE SUCTION[23 CCR§2636(ax3)] - 458 PR ^ IMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 46a. __. --._.................... ---..__0..90.NONE...._........_._.- [1 95.UNKNOWN _ 0 99_OTHER.(Specif)r...... 464a. SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464b• ❑ 90 NONE- -❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c. PIPING/TURBINE CONTAINMENT SUMP TYPE ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464d. VI. VENT,VAPOR RECOVERY (VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ 1.STEEL 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER 464e. (Specify): 464e1, VENT SECONDARY CONTAINMENT ❑ I.STEEL 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): g464fl _._._...... ......................_.__........................_.............................................._.._.........._............................_...-----'--...--'---._........._...._..-.-...._._-�._..................._._..-...----..........._..........................................._...___-______.- 4644. VR PRIMARY CONTAINMENT ❑ 1.STEEL fl 4_FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): !§!&L - VR -.... .....-.-....._....... 464h. VR SECONDARY CONTAINMENT ❑ 1.STEEL 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 464h1 VENT PIPING TRANSITION SUMP TYPE T 1.SINGLE WALL ❑ 2.DOUBLE WALL X 90,NONE 464' RISER PRIMARY CONTAINMENT 1.STEEL ❑ 4.FIBERGLASS [310.RIGID PLASTIC ❑ 90.NONE [3464j.99.OTHER(Specify): 464il RISER SECONDARY CONTAINMENT ❑ 1.STEEL _[!1 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 464k. ....................------..- _-_............................._ ._ 464 1. FILL COMPONENTS INSTALLED 1.SPILL BUCKET 3.STRIKER PLATEBOTTOM PROTECTOR ❑ 4.CONTAINMENT SUMP 45la-c. VII. UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE ® I.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469a. ..._.....__ ____.._..--- CONSTRUCTION MATERIAL ® 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 469c. VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT 6.ISOLATION 448, IX. APPLICANT SIGNATURE CERTIFICATION: I certify that this UST system is compatible with the hazardous substance stored and that the information prodded herein is true, accurate,and in full compliance with legal requirements. APPLICANT SIGNATURE DATE 8/24/2009 470 APPLICANT NAME(print) Hung Thanh Tran 471. APPLICANT TITLE Owner/Operator 472 UPCF UST-B Rev.(12/2007)-1/2 www.unidocs.org L/