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MOEN-. UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATIO (One or per UST) >r; TYPE OF ACTION (Check one item only. For an UST permanent closure or removal,complete only this section and Sections 1,11,III,IV,and IX below) 430 ® 1.NEW PERMIT El 3.RENEWAL PERMIT ❑ S.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL I: DATE UST PERMANENTLY CLOSED: a3oa DATE EXISTING UST DISCOVERED: 430b i PACILIT WFORMATI(7N FACILITY ID#(Agency Use Only) L 1 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 HIT DESCRID LEON TANK ID# 3 432 TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK IS 434 Modem Welding El LA STAND-ALONE TANK ❑2.ONE IN A COMPARTMENTED UNIT. 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 10,000 1 [ .; � TII TANI�;USE STD,CONTENTS � I .:.it .. ... ..'.:: ..' .. _.� :.: .. ..:.. . .. ..... .. .. :•:.:: ..1.':.. .. ..... I:.: .,. , : TANK USE ® I a.MOTOR VEHICLE FUELING ❑ ]b.MARINA FUELING El c.AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used 00 ❑ 5.EMERGENCY GENERATOR FUEL[RSC§25281.5(c)] ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 439a CONTENTS PETROLEUM: ❑ Ia.REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ® 1b.PREMIUM UNLEADED 440 ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ S.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM (Specify): 44Ca NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 44x6 Iy TANK CONSTRI7CTION.. . TYPE OF TANK ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 95.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 ®99.OTHER(Specify): Steel Clad w/Fiber lass Relntorced Plastic 445& 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..:PIR ODMT/ A$TEEIPYNG CONSTRUCTIDI�T PIPING CONSTRUCTION El1.SINGLE-WALLED ®2.DOUBLE-WALLED El99.OTHER 460 SYSTEM TYPE ® L PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR§2636(x)(3)] 458 PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE [310.RIGID PLASTIC 464 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464a SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464b ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c PIPING/TURBINE CONTAINMENT SUMP TYPE ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 4644 VENT PRIMARY CONTAINMENT ❑ L STEEL ® 4.FIBERGLASS ❑ ]0.RIGID PLASTIC ❑ 90.NONE ❑ STRUGTION VI VENT,VAP0A:IZECOVER (VR}AND`RI5ER'/F Y._PII'E PIPING CON �. 99.OTHER(Specify) 464e I 464e1 VENT SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify) 464F 464fl VR PRIMARY CONTAINMENT ❑ 1.STEEL N 4.FIBERGLASS ElI0.RIGIDPLASTIC [190.NONE [16 99.OTHER(Specify) 6' 464l 1 VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify) 464h 464hl VENT PIPING TRANSITION SUMP TYPE ® 1.SINGLE WALL 2.DOUBLE WALL El 90.NONE 4641. RISER PRIMARY CONTAINMENT ® I.STEEL El 4.FIBERGLASS ❑ 10.RIGID PLASTIC El90.NONE El99.OTHER(Specify) 464j f 464'1 C RISER SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10,RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify) 464k 464kl F FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET N 3.STRIKER PLATE/BOTTOM PROTECTOR ® 4.CONTAINMENT SUMP aria-c _. VIIUND ER DISPENSE$CONTAINMENT C CONSTRUCTION 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. CORROSION I'ROTECTIUN STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT `l] 6.ISOLATION 448. lX Al'�LtCAN SYGiVA CERTIFICATION: I certify that this UST s compatible with the hazardous substance stored and that the information provided herein is true,accurate, and in full com lianc it eg.,requirements. APPLICANT SIGNATURE DATE C7 /l�O 430. APPLICANT NAME(print) BRATZ013ASAGOITIA 471. APPLICANT TITLE Environmental Compliance Specialist 472. UPCF UST-A Rev.(12/2007)