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i1 UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATIO (6ne form per UST) r 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 ❑ 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 430a I DATE EXISTING UST DISCOVERED: 430b „ .. . I ACILTi Y INFORMAT14N,. FACILITY ID#(Agency Use Only) ,3 `� l tt BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 ARCO 02133 BUSINESS SITE ADDRESS 103 CITY 104 _ 2908 BENJAMIN HOLT DR STOCKTON R TANK'AFSCRIPTIO :;:, TANK ID# 2 432 TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK is 434 Modem Welding ®1.A STAND-ALONE TANK ❑ 2.ONE IN A COMPARTMENTED UNIT. l r -{• (' ;',/ _ Complete one page 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 1 TANK :. TANY C1SE;AND GONTI♦NTS ;, , USE N I a.MOTOR VEHICLE FUELING ❑ 16.MARINA FUELING ❑ lc.AVIATION FUELING ❑ 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): 439a CONTENTS PETROLEUM: N 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 ❑ 11.OTHER NON-PETROLEUM(Specify): 4aob C rYrONSTI2UCTIOlY E OF TANK ❑ 1.SINGLE WALL N 2.DOUBLE WALL ❑ 95.UNKNOWN 443 PRIMARY CONTAINMENT N 1.STEEL ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444 ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 444a SECONDARY CONTAINMENT ❑ 1.STEEL [13.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445 [_1 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 T:`PRODUCT 7'WASfiE_PIPING CON57(RUCTION PIPING CONSTRUCTION F]1.SINGLE-WALLED N 2.DOUBLE-WALLED [199.OTHER 460 SYSTEM TYPE N 1.PRESSURE El 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION [14.SAFE SUCTION[23 CCR§2636(a)(3)] 454 PRIMARY CONTAINMENT [:] 1.STEEL N 4.FIBERGLASS [j8.FLEXIBLE ❑ 10.RIGID PLASTIC 464 El 90.NONE El 95.UNKNOWN Cl 99.OTHER(Specify): 464a SECONDARY CONTAINMENT ❑ 1.STEEL N 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464b El90.NONE [:195.UNKNOWN [199.OTHER(Specify): 464c PIPING/TURBINE CONTAINMENT SUMP TYPE N 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464d YID`VENT,rVAPOR RECOVERX(VR)AN1?:RISER/FILL PIPE FIItw(;co TRUCTI..ON. VENT PRIMARY CONTAINMENT ❑ 1.STEEL N 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464e 464el VENT SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC N 90.NONE ❑ 99.OTHER(Specify) 464f 464n VR PRIMARY CONTAINMENT ❑ 1.STEEL N 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 4648 464 1 VR SECONDARY CONTAINMENT ❑ 1.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 4641, RISER PRIMARY CONTAINMENT N 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 4641 464'1 RISER SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC N 90.NONE ❑ 99.OTHER(Specify) 464k 464kl FILL COMPONENTS INSTALLED N 1.SPILL BUCKET N 3.STRIKER PLATE/BOTTOM PROTECTOR N 4.CONTAINMENT SUMP 45 to-c VII UNDER DISPENSER CONTAIIYIVIENT([IDG) CONSTRUCTION TYPE N 1.SINGLE WALL Ll2.DOUBLE WALL [13.NO DISPENSERS ❑ 90.NONE 469a CONSTRUCTION MATERIAL ❑ 1.STEEL N 4.FIBERGLASS [I10.RIGID PLASTIC El 99. (Spec fy) a696 c VIYI. CORROSION:I'ROTECTION .I STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT © 6.ISOLATION 448. SIGNATURI; CERTIFICATION:I certify that this UST syste'miA compatible with the hazardous substance stored and that the information provided herein is true,accurate, and in full com Iiancetvlt al requirements. 470. APPLICANT SIGNATURE DATE APPLICANT NAME(print) BRATZO-BASAGOITIA 471- APPLICANTTULE Environ/mJental Compliance Specialist 4'2. UPCF UST-A Rev.(12/2007)