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/ / UNDERGROUND STORAGE TANK 5zt OPERATING PERMIT APPLICATION-TANK INFORMATION(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,11,111,IV,and IX below) 430 ® 1.NEW PERMIT ❑ 3,RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 43oa DATE EXISTING UST DISCOVERED: 430b ., 7. TK �' ACItdTY INFORMATIONwo FACILITY ID#(Agency Use Only) BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 ARCO 02133 BUSINESS SITE ADDRESS 103 CITY 164 2908 BENJAMIN HOLT DR STOCKTON i' II 'ArTKa)I+SCRII'TION TANK ID# 1 432 TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK 15 434 Modem Welding ®1.A STAND-ALONE TANK ❑2.ONE IN A COMPARTMENTED UNIT. 1 Complete one pW for each compartment in the unit. DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 1999/04 12,000 _ III'TANKUSE AND Cp1�T�NTS -: TANK USE ® ]a.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ I c.AVIATION FUELING 9 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§25281.5(c)] ❑ 6.OTHER GENERATOR FUEL El95.UNKNOWN El99.OTHER(Specify): 439a CONTENTS PETROLEUM: ® la.REGULAR UNLEADED ❑ lc.MIDGRADE UNLEADED ❑ lb.PREMIUM UNLEADED 440 ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM (specify): 440a NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL 4406 ❑ 11,OTHER NON-PETROLEUM. S ecify: F TANKCO�YSTRUCI'TON TYPE OF TANK ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 95.UNKNOWN 443 PRIMARY CONTAINMENT ® 1.STEEL ❑ 3.FIBERGLASS [16.INTERNAL BLADDER 444 ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 444a SECONDARY CONTAINMENT ❑ 1.STEEL ❑3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445 ❑ 90.NONE ❑ 95.UNKNOWN ®99.OTHER(Specify): Steel Clad w/Fiberglass Reinforced Plastic 445a OVERFILL PREVENTION Lg 1.AUDIBLE&VISUAL ALARMS R 2.BALL FLOAT ❑ 3.FILL TUBE SHUT-OFF VALVE 452' ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V'`PRODTJCT/WASTE PIPING CONSTRUCTIQl�T PIPING CONSTRUCTION Ll1.SINGLE-WALLED ®2.DOUBLE-WALLED El99.OTHER 460 SYSTEM TYPE ® L PRESSURE L12.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR§2636(a)(3)1 458 PRIMARY CONTAINMENT ❑ I.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464 ❑ 90.NONE [195.UNKNOWN El99.OTHER(Specify): 464a SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS [I8.FLEXIBLE ❑ 10.RIGID PLASTIC 4646 ` [190.NONE ❑ 95.UNKNOWN [199.OTHER(Specify): 464c PIPING/TURBINE CONTAINMENT SUMP TYPE M 1 SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90 NONE YI:ANT,VAPOR RECQVEIY(t?It).AND°ARSE /� [.L PIPE.I' TNG CONS RUCTION • VENT PRIMARY CONTAINMENT ❑ 1.STEEL M 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 4664e14el k VENT SECONDARY CONTAINMENT ❑ 1.STEEL El4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify) 464f 464fl VR PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 4649 464 al VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS [110.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify) 464h 464h1 VENT PIPING TRANSITION SUMP TYPE ® 1.SINGLE WALL 2.DOUBLE WALL ❑ 90.NONE 464'. RISER PRIMARY CONTAINMENT ® 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 4641 464'1 RISER SECONDARY CONTAINMENT ].STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify) 464k 464k1 FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET ® 3.STRIKER PLATE/BOTTOM PROTECTOR ® 4.CONTAINMENT SUMP VII.UND ER I)LSPENb'ER CONTAINMENT;(UDC) CONSTRUCTTON TYPE ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469a CONSTRUCTION MATERIAL ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 469b-c > ' ,' VIII C ON PROTECTION' :. ORROSI STEEL COMPONENT PROTECTION [12.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT 01*6 ISOLATION 448' IX.'AI'PUC.ANTSYGNATURE CERTIFICATION: I certify that this UST syst ompatible with the hazardous substance stored and that the information provided herein is true,accurate, and in full compliance al re uirements. APPLICANT SIGNATURE DATE 470, APPLICANT NAME(print) BRA ASAGOITIA all. APPLICANT TITLE Environme tal Compliance Specialist 472. i F IJPCF UST-A Rev.(12/2007) I i