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UNDERGROUND STORAGE TANK u_1[e O� ' OPERATING PERMIT APPLICATION-TANK INFORMATIO ( ne formUST er P ) 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 ® 1.NEW PERMIT ❑ 3.RENEWAL PERMIT El 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT-CLOSURE ON SITE ❑ S.UST REMOVAL DATE UST PERMANENTLY CLOSED: 430a DATE EXISTING UST DISCOVERED: 430b Y . ACILI' rY.TI�IFORMATIQN FACILITY ID#(Agency Use GnI)) h t n d� BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) ARCO 02133 BUSINESS SITE ADDRESS 103 CITY 104 2908 BENJAMIN HOLT DR ISTOCKTON II TANK'p>±SGRIT ON h. TANK ID# 2 432 TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK IS 434 Modem Welding ®I.A STAND-ALONE TANK complete 2.O T IN C COMPARTMENTED tUNIT.ist. r for�ch mmpartment in DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 1999/04 12,000 I III TANK YrSE A"'; ONTINt TANK USE N la.MOTOR VEHICLE FUELING [IIb.MARINA FUELING ❑ 1c.AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§25251.5(c)] ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 439a CONTENTS PETROLEUM: N la.REGULAR UNLEADED ❑ lc.MIDGRADE UNLEADED ❑ lb.PREMIUM UNLEADED 440 ❑ 3.DIFSEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ S.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM (Specify): 440a NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL E311,OTHER NON-PETROLEUM(Specify): 44ab IV TANK CONSTRUCTICIN. TYPE OF TANK ❑ 1.SINGLE WALL N 2.DOUBLE WALL Ll95.UNKNOWN 443 PRIMARY CONTAINMENT ® 1.STEEL ❑ 3.FIBERGLASS ❑ 6.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 N 99.OTHER(Specify): Steel Clad w/Fiberglass Reinforced Plastic 445a OVERFILL PREVENTION ® 1.AUDIBLE&VISUAL ALARMS N 2.BALL FLOAT ❑ 3.FILL TUBE SHUT-OFF VALVE 452. ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. DUCT Z'WASTEPIPING C�N.STLtiJCFION, PIPING CONSTRUCTION El1.SINGLE-WALLED N 2.DOUBLE-WALLED 1199.OTHER 460 SYSTEM TYPE N 1.PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION 123 CCR§2636(a)(3)] 456 PRIMARY CONTAINMENT ❑ 1.STEEL N 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGIDPLASTIC 464 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464a SECONDARY CONTAINMENT El1.STEEL N 4.FIBERGLASS El8.FLEXIBLE ❑ 10.RIGIDPLASTIC 464b ❑ 90.NONE [195.UNKNOWN [199.OTHER(Specify): 464c PIPING/TURBINE CONTAINMENT SUMP TYPE ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464d VI VEIL I,'VAIpOIf:;1IECOYERY(VR)A�'D.RISER 7 FILL PIP19 PII'Il�1G CONSTRUCTION. VENT PRIMARY CONTAINMENT ❑ L STEEL N 4.FIBERGLASS ❑ 10.RIGIDPLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464e 464el VENT SECONDARY CONTAINMENT ❑ L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC N 90.NONE ❑ 99.OTHER(Specify) 464f 4641 VR PRIMARY CONTAINMENT ❑ 1.STEEL N 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 9D.NONE ❑ 99.OTI-]ER(Specify) 464s 464 1 VR SECONDARY CONTAINMENT ❑ L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC N 90.NONE ❑ 99.OTHER(Specify) 464h 464hl VENT PIPING TRANSITION SUMP TYPE N 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464i. RISER PRIMARY CONTAINMENT N 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 4641 464.1 RISER SECONDARY CONTAINMENT ❑ I.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC N 90.NONE ❑ 99.OTHER(Specify) 464k 464k1 FILL COMPONENTS INSTALLED N 1.SPILL BUCKET N 3.STRIKER PLATE/BOTTOM PROTECTOR N 4.CONTAINMENT SUMP 451a-c :VII USER;DISPEM...ERGONTAINMENT'(UDQP: CONSTRUCTION TYPE N 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90,NONE 469a CONSTRUCTION MATERIAL ❑ 1.STEEL N 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 469b-c ,. . : ;; ..... ;` ,;VI[I._ CORROSION-,PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT 6.ISOLATION 446• IX AEPt.ICANTSIGNATURI; f CERTIFICATION:I certify that this UST syste'mfi compatible with the hazardous substance stored and that the information provided herein is true,accurate, and in full com liancewlt al requirements. 470. APPLICANT SIGNATURE DATE 14,171 APPLICANT NAME(print) BRAT'ZMASAGOITIA 471. APPLICANTTITLE Environmental Compliance Specialist 472. UPCF UST-A Rev.(12/2007)