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UNDERGROUND STORAGE TANK 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,II,II1,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 f': DATE UST PERMANENTLY CLOSED: 430. DATE EXISTING UST DISCOVERED: 430b L FAA LITY INFoRmATION FACILITY ID 4(Agency Use Only) BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 ARCO 02133 BUSINESS SITE ADDRESS 103 CITY 104 2908 BENJAMIN HOLT DR ISTOCKTON II TANK DESCRIPTION TANK ID# 3 432 TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK IS 434 Modem Welding ®1.A STAND-ALONE TANK ❑2.ONE IN A COMPARTMENTED UNIT. Complete one pa3e for each compartment in the unit. DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 1999104 10,000 1 III TANK.-USE AND.CONTENTS TANK USE N la.MOTOR VEHICLE FUELING El 1b.MARINA FUELING El 1G.AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§25281.5(e)] ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 4391 CONTENTS PETROLEUM: ❑ 1 a.REGULAR UNLEADED ❑ le.MIDGRADE UNLEADED ® lb.PREMIUM UNLEADED 440 ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM (Specify): 440a i NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON PETROLEUM(Specify) 'TANKCOIVSTRUCTION aaob' TYPE OF TANK ❑ 1.SINGLE WALL N 2.DOUBLE WALL ❑ 95.UNKNOWN 443 PRIMARY CONTAINMENT N 1.STEEL ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444 i ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 444a i SECONDARY CONTAII4MENT ❑ 1.STEEL ❑3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445 ❑ 90.NONE ❑ 95.UNKNOWN N 99.OTHER(Spec/ ): Steel Clad w/Fiberglass coating 445& OVERFILL PREVENTION 1.AUDIBLE&VISUAL ALARMS N 2.BALL FLOAT Lo 3•FILL TUBE SHUT-OFF VALVE 452. ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V.'PRODUCT I WASTE'PIPING CONSTRUCTION PIPING CONSTRUCTION ❑1.SINGLE-WALLED ®2.DOUBLE-WALLED ❑99.OTHER 460 SYSTEM TYPE ® 1.PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCA§2636(.)(3)] 458 PRIMARY CONTAINMENT ❑ 1.STEEL N 4•FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464a SECONDARY CONTAINMENT ❑ 1.STEEL N 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464b ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c PIPING/TURBINE CONTAINMENT SUMP TYPE N 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464d VL.VENT;VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIl'ING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ 1.STEEL N 4.FIBERGLASS [110.RIGID PLASTIC El90.NONE [199.OTHER(Specify) 464e f VENT SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC N 90.NONE ❑ 99.OTHER(Specify) 464f VR PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC [190.NONE E399.OTHER(Specify) 4648 VR SECONDARY CONTAINMENT ❑ 1.STEEL [14.FIBERGLASS ❑ 10.RIGIDPLASTIC N 90.NONE El99.OTHER(Specify) 464h VENT PIPING TRANSITION SUMP TYPE N 1,SINGLE WALL El2.DOUBLE WALL ❑ 90.NONE 4641 RISER PRIMARY CONTAINMENT N L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 4643 464'1 RISER SECONDARY CONTAINMENT ❑ 1.STEEL [14.FIBERGLASS ❑ 10.RIGID PLASTIC N 90.NONE 1199.OTHER(Specify) 464k 464k1 FILL COMPONENTS INSTALLED N 1.SPILL BUCKET N 3.STRIKER PLATEBOTTOM PROTECTOR N 4.CONTAINMENT SUMP 451a-c VII UNDER DISPENSER CONT AINMENT(UDC) CONSTRUCTION TYPE N 1,SINGLE WALL ❑ 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469a CONSTRUCTION MATERIAL ❑ 1.STEEL N 4.FIBERGLASS ElI0.RIGIDPLASTIC [199.OTHER(Specify) - 4696c VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT N 6.ISOLATION 448• IX: APPLICANT:SIGNATrtTRE CERTIFICATION: I certify that this UST system is compatible with the hazardous substance stored and that the information provided herein is true,accurate, and in full com liancewith legal requirements. APPLICANT SIGNATURE!_ DATE 470 APPLICANT NAME(print) ,J�NNI R,M. MARINAS 47 APPLICANT TITLE Environmental Compliance Sect list 472. ,a UPCF UST-A Rev.(12/2007)