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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANKQ OPERATING PERMIT APPLICATION-TANK INFORMATION(one form per us-r) TYPE OF ACTION (Check one item only. For an UST permanent closure or removal,complete only this section and Sections 1,I1,111,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 DATE EXISTING UST DISCOVERED' 430b L FACILITY INFORMATION FACILITY ID 9(Agency Use Only) t BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 ARCO#06080 BUSINESS SITE ADDRESS 103 CITY 104 85 East Lousie Avenue Lathrop 11.TANK DESCRIPTION TANK ID it 2 432 TANK MANUFACTURER 423 TANK CONFIGURATION: TI IIS TANK IS 434 Containment Solutions ❑1.A STAND-ALONE TANK ®2.ONE IN A COMPARTMENTED UNIT. 4 Complete one page for each compartment in the unit ATG US SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER CP COMPARTMENTS IN THE UNIT 437 2010/12 12,000 2 III.TANK USE AND CONTENTS TANK USE ® la.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ Ic.AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4_HAZARDOUS WASTE(Includes Uacd Oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§252815(c)] ❑ 6,OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 439a CONTENTS PETROLEUM- ❑ la.REGULAR UNLEADED ❑ Ic.MIDGRADF.UNLEADED ® lb.PREMIUM UNLEADED 440 ❑ 3 DIESEL ❑ 5 JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9 01TIER PETROLEUM (Specify): 440a NON-PETROLEUM: 7.USED OIL ❑ 10.E'T'HANOL ❑ 11,OTHER NON-PETROLEUM(Specify): 440b 1V. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ® 2.DOUBLE WALL. ❑ 95,UNKNOWN 443 PRIMARY CONTAINMENT ❑ 1.STEEL 3.FIBERGLASS ❑ 6.INTERNAL BLADDER W. ❑ 7.STEEL+INTERNAL LINING ❑ 95 UNKNOWN ❑ 99.OTHER $ 1 444a SECONDARY CONTAINMENT ❑ I.STEEL ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7,JACKETED 445 ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specify): 445a OVERFILL PREVENTION 1.AUDIBLE 6t VISUAL ALARMS 2.BALL FLOAT 3.FILL TUBE SHUT-OFF VALVE 452 ❑ 4. FANK MLE-1S REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑1.SINGLE-WALLED ®2.DOUBLE-WALLED ❑99.0"CHER 460 SYSTEM TYPE 1.PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION 4.SAFE SUCTION 123 CCR{2636(.X3)1 458 PRIMARY CONTAINMENT ❑ I.STEEL ® 4.FIBFRGLASS ❑ 8.FLEXIBLE 0 10.RIGID PLASTIC 464 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTIIER(Specify): 464a SECONDARY CONTAINMENT L STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE E3 10.R[GID PLASTIC 464b ❑ 90 NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c PIPINGITURBINE CONTAINMENT SUMP TYPE ❑ 1 SINGLE WALL ® 2.DOUBLE WALL ❑ 90,NONE 4644 VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT 1,STEEL 19 4.FIBERGLASS 10 RIGID PLASTIC: C1 90 NONE 0 99 OTHER(Specify) 464e 464el VENT SECONDARY CONTAINMENT 1.STEEL ® 4.FIBERGLASS 10.RIGID PLASTIC 13 90,NONE 99.OTHER(Specify) 464f 4(An VR PRIMARY CONTAINMENT 1,STEEL CM 4.FIBERGLASS 0 10,RIGID PLASTIC 0 90.NONE 99.OTHER(Specify) 4648 464 I VR SECONDARY CONTAINMENT 0 1 STEEL 0 4 FIBERGLASS 10,RIGID PLASTIC 90,NONE 99.OTHER(Specify) 464h 464h1 VENT PIPING TRANSITION SUMP TYPE ❑ 1 SINGLE WALL ® 2.DOUBLE WALT. ❑ 90.NONE 4641 RISER PRIMARY CONTAINMENT ® 1 STEEL 4.FIBERGLASS 10.RIGID PLASTIC E3 90.NONE 0 99.OTHER(Specify) 464j 4641 RISER SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 1 RIGID PLASTIC 0 90.NONE 99 OTHER(Specify) 464k 464k1 FILL COMPONENTS INSTALLED 1.SPILL BUCKET 0 3.STRIKER PLATE/BOTTOM PROTECTOR 4.CONTAINMENT SUMP 4518-c VII.UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ❑ 1.SINGLE WALL. ® 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469a CONSTRUCTION MA'T'ERIAL ❑ 1.S'T'EEL ® 4 FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHERS if 469b-c VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODF.(S) ❑ 4 IMPRESSED 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 SIGNA'T'URE DATE 10/12/201 APPLICANT NAME(print) R.t.-Gossett 471 APPLICANT TITLE Environmental Compliance Specialist 472 UPCF UST-B-1/2 Rev.(12/2007)