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9 Lk UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION(o*Ak HiM Id TYPE OFA�j�ACTI40N (Check one item only. For an UST permanent closure or removal,complete only this section and Sections 1,11,111,IV,and ix below) 430 E] 1.NEW PERMIT [:13.RENEWAL PERMIT 0 5.CHANGE AHMMMENTAL [1 6.TEMPORARY UST CLOSURE C1 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REM 11,11-In 430b DATE UST PERMANENTLY CLOSED: 4jua I DATE EXISTING UST DISCOVERED: DEWTMENT I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) National Petroleum-Stockton 103 CITY 104 BUSINESS SITE ADDRESS Stockton 713 N.El Dorado St. It.TANK DESCRIPTION 434 43 TANK MANUFACTURER _T33 TANK CONFIGURATION: THIS TANK IS TANK ID# TA0515678 Xerxes ❑1.A STAND-ALONE TANK 2.ONE IN A COMPARTMENTED UNIT. Complete one page for each compaliment in the unit. 437 DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 124 0/2003 8,000 2 III.TANK USE AND CONTENTS 439 TANK USE ® la.MOTOR VEHICLE FUELING D Ib.MARINA FUELING 0 Ic.AVIATION FUELING 0 3.CHEMICAL PRODUCT STORAGE D 4.HAZARDOUS WASTE(includes Used Oil) D 5.EMERGENCY GENERATOR FUEL[HSC§25281.5(c)] 439a El 6.OTHER GENERATOR FUEL D 95.UNKNOWN D 99.OTHER (Specify): 440 CONTENTS PETROLEUM: El Ia.REGULAR UNLEADED D lc.MIDGRADE UNLEADED ❑ Ib.PREMIUM UNLEADED 0 3.DIESEL 0 5.JET FUEL ❑ 6.AVIATION GAS 440a D 8.PETROLEUM BLEND FUEL D 9.OTHER PETROLEUM (Specify): ON-PETROLEUM:D 7.USED OIL D 10.ETHANOL 440b 0 11.OTHER NON-PETROLEUM(Specify): IV. TANK CONSTRUCTION 443 TYPE OF TANK D 1.SINGLE-WALL 0 2 DOUBLE WALL U 95.UNKNOWN TiT- PRIMARY CONTAINMENT- ❑ 1.STEEL W 3.FIBERGLASS U 6.INTERNAL BLADDER 444a ❑ 7.STEEL+INTERNAL LINING 0 95.UNKNOWN D 99.OTHER (Specify): 445 SECONDARY CONTAINMENT 0 1.STEEL Dg 3.FIBERGLASS D 6.EXTERIOR MEMBRANE LINER Lj 7.JACKETED 445a ❑ 90.NONE D 95.UNKNOWN D 99.OTHER(Specify): 452. OVERFILL PREVENTION 1.AUDIBLE&VISUAL 0 2.BALL FLOAT W 3.FILL I U13b SHUT-OFF VALVE 4.TANK M�EETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION 460 PIPING CONSTRUCTION 0 1.SINGLE-WALLED 0 2.DOUBLE-WALLED D 99.OTHER SYSTEM'__�YPE MARY CONTAINMENT ONTA 7 NT CONTAINMENT O PIPING M LPRESSURE U 2.GRAVITY El 3.CONVENTIONAL SUCTION D 4.SAFE SUCTION[23 CCR§2636(a)(3)] 458 TYPE 464 PRIMARY CONTAINMENT 0 LSTEEL 0 4.FIBERGLASS U 8.FLEXIBLE D 10.RIGID PLASTIC 464a Fl 90.NONE D 95.UNKNOWN D 99.OTHER(Specify): FIBERGLASS ❑ 8.FLEXIBLE D 10.RIGID PLASTIC 464b SECONDARY CONTAINMENT D LSTEEL k9 4. 464c El 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464d PIPING/TURBINE CONTAINMENT SUMP TYPE )g.1 SINGLE WALL 0 2.DOUBLE WALL ❑ 90.NONE VT.VENT,VAPOR RECOVERY(VR)AND RISER/FELL PIPE PIPING CONSTRUCTION FO-14K 0 99-OTHER(Specify) 464e VENT PRIMARY CONTAINMENT ❑ 1.STEEL E9 4.FIBERGLASS D 10.RIGID PLASTIC C190. 464el 464f VENT SECONDARY C0NT,UI,1L'1.1E-'qT STEEL 4.FIBERGLASS 1 10.RIGID PLASTIC 0 90.NONE U 99.()'MER(Specify) 464n 464g VR PRIMARY CONTAINMENT ❑ 1.STEEL 4.FIBERGLASS ❑ 10.RIGID PLASTIC D 90.N D 99.OTHER(Specify) 464 VR SECCIIJEldIA'.CONTAINMENT §§ D 10.RIGID PLASTIC [1 90.NONE D 99.OTHER(Specify) 464h ArNMENT 0 STEEL C9 4.FIBERGLASS 464h1 El 2.DOUBLE WALL 0 90.NONE 4641. VENT PIPING TRANSITION SUMP TYPE 0 1.SINGLE WALL 464] Y S ❑ 10.RIGID PLASTIC Ll 90.NONE Lj 99.OTHER 1 HER(Specify) RISER PRIMARY CONTAINMENT AINMENT [9 LSTEEL D 4.FIBERGLAS �6�4jil VENT SECONDARY CONTAINMENT 0 1.STEEL 1 4.FIBERGLASS 0 1).RIGID PLASTIC 0 go.NONE D 99.OTHER(Specify) 464kl PROTECTOR CONTAINMENT SUMP 45la-c FILL COMPONENTS INSTALLED ED 1.SPILL BUCKET 0 3 PLATEIBOTTOM VII.UNDER DISPENSER CONTAINMENT(UDC) 469a CONSTRUCTION TYPE M I SINGLE WALL D 2.DOUBLE WALL 0 3.NO DISPENSERS D 90.NONE 4696-c CONSTRUCTION MATERIAL ❑ LSTEEL 0 4.FIBERGLASS D 10.RIGID PLASTIC Q 99.OTHER(Specify) VM. CORROSION PROTECTION 449. STEEL COMPONENT PROTECTION D 2.SACRIFICIAL ANODE(S) D 4.IMPRESSED CURRENT 0 6.ISOLATION 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 reguirements. -470 C T TU DATE 3/20/2014 APPLICANT SIGNATURE 472. P 471 APPLICANT NAME(print) Nick Patel APPLICANT TITLE Manager Rev.(12/2007)