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UNDERGROUND STORAGE TANK OPERATING PERNUT APPLICATION-TANK INFORMATION(One fomi per UST) 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 INFORIP,TION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 430a DATE EXISTING UST DISCOVERED: 430b I. FACILTTY INFORMATION FACILITY ID#(Agency Use Only) a.- 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 A. ON j. TANK ID# 3 432 TANK MANUFACTURER NK X4333 TANK CONFIGURATION: THIS TANK IS 434 = Modem Welding ®1.A STAN�TD-ALONE TANK T y Y,r �> �- ❑2.ONE INA COMPARTMENTED UNIT.% ( complete one page for each compamnent 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 III: TANK USE AND.CONTENTS TANK USE ® la.MOTOR VEHICLE FUELING ❑ lb.MARINA FUELING ❑ Ic.AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ❑ S.EMERGENCY GENERATOR FUEL[HSC§25231.5(c)] ❑ 6.OTHER GENERATOR FUEL [195.UNKNOWN ❑ 99.OTHER(Specify): 439a CONTENTS PETROLEUM: ❑ l a.REGULAR UNLEADED ❑ le.MIDGRADE UNLEADED ® lb.PREMIUM UNLEADED 440 ❑ 3.DIESEL ❑ 5.]ET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM (Specify): 440a c NON-PETROLEUM:❑ 7.USED OIL ❑ 10,ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 440b TV;;TANK CONSTRUCTION ; I TYPE OF TANK ❑ 1.SINGLE WALL N 2.DOUBLE WALL ❑ 95.UNKNOWN 443 PRIMARY CONTAINMENT ® 1.STEEL ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444 ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN [399.OTHER (Specify): 44aa SECONDARY CONTAINMENT ❑ 1.STEEL ❑3.FIBERGLASS ❑ &EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445 ❑ 90.NONE ❑ 95.UNKNOWN N 99.OTHER(Specify): Steel Clad wNiberglass coating 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.!PRODUCT'%WASTE'PIPING CONSTRUCTION: PIPING CONSTRUCTION ❑1.SINGLE-WALLED N 2.DOUBLE-WALLED El 99. 460 SYSTEM TYPE ® 1.PRESSURE L12.GRAVITY Ll 3.CONVENTIONAL SUCTION El 4.SAFE SUCTION[23 CCR§2636(a)(3)] 458 PRIMARY CONTAINMENT ❑ 1.STEEL N 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464 ❑ 90.NONE [195.UNKNOWN ❑ 99.OTHER(Specify): 464a t SECONDARY CONTAINMENT ❑ 1.STEEL N 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464b ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): PIPING/TURBINE CONTAINMENT SUMP TYPE ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE a64a VLVENT, VAPORRECOVERX(VR) RISE FILL.PIISE PIPING CONSTItUGTION } VENT PRIMARY CONTAINMENT ❑ 1.STEEL N 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464* j: VENT SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGIDPLASTIC N 90.NONE ❑ 99.OTHER(Specify) 464f l VR PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS El 10.RIGIDPLASTIC [390.NONE [399.OTHER(Specify) 4648 i VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC N 90.NONE 1199.OTHER(Specify) 464h VENT PIPING TRANSITION SUMP TYPE N 1,SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464L RISER PRIMARY CONTAINMENT N 1.STEEL [14.FIBERGLASS ❑ 10.RIGID PLASTIC El90.NONE [:] 99.OTHER(Specify) 4641 464'1 RISER SECONDARY CONTAINMENT ❑ 1.STEEL [14.FIBERGLASS El10.RIGID PLASTIC ® 90.NONE. ❑ 99.OTHER(Specify) 4641 46411 FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET N 3.STRIKER PLATE/BOTTOM PROTECTOR N 4.CONTAINMENT SUMP asla-c VII UNDER`DISPENSER CONTAINIKENT'(UDC);', . CONSTRUCTION TYPE ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469a CONSTRUCTION MATERIAL ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC [j99.OTHER(Specify) - 469hc VIII: CORROSION EROTE CTION `: STEEL COMPONENT PROTECTION El2.SACRIFICIAL ANODE(S) El4.1MPRESSED CURRENT ® 6.ISOLATION 448. IX::APPLICANT SIGNATURE 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 compliance with legal requirements. APPLICANT SIGNATURE/ DATE 470 APPLICANT NAME(print)(1JFNN1 �R M. MARINAS 471- APPLICANT TITLE Environmental Compliance Sheol list 472' UPCF UST-A Rev.(12/2007)