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UNIFIED PROGRAM CONSOLIDATED FORMG�7""'/`- �g�I UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION(One form per UST) TYPE OF ACTION (Check one itein only. For an UST permanent closure or removal,complete only this section and Sections 1,11,111,IV,and IX below) 470 ® I.NEW PERMIT ❑ 3.RENEWAL PERMIT ❑ 5,CHANGE OF INFORMATION ❑ 6.TEMPORARY US'r CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 430a DATE.EXISTING UST DISCOVERED: 430b I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) _ 3 1 u 2 b 1 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 ARCO#06080 BUSINESS SITE ADDRESS 103 CITY loo 85 East Lousie Avenue Lathrop II.TANK DESCRIPTION TANK ID# 1 432 TANK MANUFACTURER 473 TANK CONFIGURATION: THIS TANK IS 414 Containment Solutions 0 LA STAND-ALONE TANK T D [12.ONE IN A COMPARTMENTED UNIT. Complete one page for each com ment in the unit. DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 2010/12 20,000 1 III.TANK USE AND CONTENTS TANK USE ® Ia.MOTOR VEIIICLE FUELING ❑ lb.MARINA FUELING ❑ lc.AVIATION FUELING 439 ❑ 3.CIIEMICAL 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: ® la.REGULAR UNLEADED ❑ Ic.MIDGRADF.UNLF.ADF.D ❑ lb.PREMIUM UNLEADED 440 ❑ 3.DIESEL ❑ 5,JET FUEL ❑ 6,AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM S if : 440a NON-PETROLEUM:0 7.USED OIL ❑ 10 ETHANOL ❑ I I.OTHER NON-PF.TROLF:UM S d) 44nh IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WAIL ® 2.DOUBLE WALL ❑ 95.UNKNOWN 443 PRIMARY CONTAINMENT ❑ I.STEEL 3.F113ERGLASS ❑ 6.INTERNAL BLADDER 444 ❑ 7.STEEL+INTERNAL I.IWING ❑ 95.UNKNOWN ❑ 99.OT ER $ i 444a SECONDARY CONTAINMENT [11.STEEL 3.FIBERGLASS [16 EXTERIOR MEMBRANE LINER 7,JACKETED 445 ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specify) 445a OVERFILL PREVENTION 1.AUDIBLE&VISUAT7A1A_RM_,S_M 2.BALL FLOAT 6 3.FILL TUBE SHUT-OFF VALVE 452 ❑ 4.TANK MEETS REQUIREMENTS FOR EXLMP"TION FROM OVERFILL PREVENTION F.QIJIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION El 1.SINGLE-WALLED M 2.DOUBLE-WALLED ❑99.OTHER 460 SYSTEM TYPE ® L PRESSURE ❑ 2.GRAVI'lY 3 CONVENTIONAL SUCTION ❑ 4_SAFE SUCTION 123 CCR j2&36(&X3)I 4S8 PRIMARY CONTAINMENT 1.STEEL 4 FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHF.R(S i ): 464a SECONDARY CONTAINMENT ❑ I.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 464d VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT I STEEL 0 4.FIBERGLASS 10 RIGID PLASTIC 0 90.NONE El 99 OTHER(Specify) 464e 464c1 VI-.NT SECONDARY CONTAINMENT I STF,FL 4.FIBERGLASS 10.RIGID PLASTIC 0 90 NONE. 99.OTHER(Specify) 464f 46411 VR PRIMARY CONTAINMENT ❑ I SI'LEI, 4.FIBERGLASS 10.RIGID PLASTIC D 90 NONE C3 99 OTI IFR(Specify) 464g 464al VR SECONDARY CONTAINMENT ❑ 1 STEEL Is 4,FIBERGLASS El 10.RIGID PLASTIC 0 90 NONE ❑ 99 OTHER(Specify) 464h 464hl VENT PIPING TRANSITION SUMP TYPE C1 I SINGLE WALL 1@ 2.DOUBLE WALL 90.NONE 4611 RISER PRIMARY CON'T'AINMENT Dg 1 STEEL 4.FIBERGLASS Ll 10.RIGID PLASTIC L3 90.NONE U 99.OTHER(Specify) �1 464'I RISER SECONDARY CONTAINMENT I.STEEL 13 4.FIBERGLASS 13 10.RIGID PLASTIC El 90.NONE Q 99.OTHER(Specify) 464k 464k1 FILL COMPONENTS INSTALLED 1.SPILL BUCKET 0 3.STRIKER PLATE/BOTTOM PROTECTOR 0 4.CONTAINMENT SUMP 45la-c VII.UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ❑ I SINGLE WALL ® 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 459a CONSTRUCTION MATERIAL ❑ I.STEEL ® 4 FIBERGLASS ❑ 10 RIGID PLASTIC 0 99.OTHER(Specify) 469b-c VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ® 6.ISOLATION 448 IX. APPLICANT SIGNATURE CERTIFICATION: 1 certify that this US'F 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 10/12/2010 470 APPLICANT NAME(print) R.C.Gossett 471 APPLICANT TITLE Environmental Compliance Specialist 47 CPCF UST-B-1/2 Rev.(12/2007)