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D�) UNIFIED PROGRAM CONSOLIDATED FORM g I UNDERGROUND STORAGE TANK ,�l � ��' O OPERATING PERMIT APPLICATION-TANK INFORMATION(One form per 11S TYPE OF ACTION (Check one item only. For an UST permanent closure or removal,complete only this section and Sections I,11,III,IV,and IX below) 410 ® 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: 43041 DATE EXISTING UST DISCOVERED: d706 L FACILITY INFORMATION FACILITY ID#(Agency Use Only) BUSINESS NAME(Same as FACILITY NAME or DAA-Doing Business As) 3 ARCO#06080 BUSINESS SITE ADDRESS 103 CITY 104 85 East Lousie Avenue Lathrop II.TANK DESCRIPTION TANK ID# 3 432 TANK MANUFACTURER 433 TANK CON FIGURATION: THIS TANK IS 434 Containment Solutions ❑I.A STAND-ALONE TANK 2 ®2.ONE IN A COMPARTMENTED UNIT, Complete one page for each com anment in the unit DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 2010/12 10,000 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 Used Oil ❑ 5.EMERGENCY GENERATOR FUEL[HSC$25281 5(c)] 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 439s CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED ❑ lc.MIDGRADE UNLEADED ❑ Ib.PREMIUM UNLEADED 440 ® 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PL•TROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM (Specify): 4404 NON-PETROLEUM:0 7 USED OIL 10.ETHANOL ❑ 11.OTI IER NON-PETROLEUMS 440b IV. TANK CONSTRUCTION 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): 4444 SECONDARY CONTAINMENT L.STEEL ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445 ❑ 90.NONE ❑ 95.UNKNOWN [199.OTHER(Specify): 445a OVERFILL PREVENTION 1.AUDIBLE&VISUAL ALARMS 2.BALI.FLOAT 3.FILL TUBE SHUT-OFF VALVE 45: ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑I.SINGLE-WALLED ®2.DOUBLE-WALLED ❑99,OTHER 460 SYSTEM TYPE ® 1.PRESSURE ❑ 2.GRAVITY 0 3,CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION 23 CCR 1,x3 458 PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS 8.FLEXIBLE ❑ 10 RIGID PLASTIC 464 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHERS I ): 464a SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS 8.FLEXIBLE ❑ 10.RIGID PLASTIC 46413 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(S ecif): 464c PIPING/TURBINF.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 0 1.STEEL. 0 4.FIBERGLASS 0 10.RIGID PLASTIC tj 90.NONE 0 99-OTHER(Specify) 464c 464c1 VENT SECONDARY CONTAINMENT 1.STEEL. 4 FIBERGLASS 10.RIGID PLASTIC 90 NONE 99 OTHER(Specify) 4641' 4611'1 VR PRIMARY CONTAINMENT ❑ L STEEL 4.FIBERGLASS ❑ 10.RIGID PLASTIC 90.NONE 99.OTHER(Spocify) 4648 464SI VR SECONDARY CONTAINMENT I.STEEL 0 4 FIBERGLASS ❑ 10 RIGID PLASTIC 90 NONE. 99 OTHER(Specify) 464h 4t,4hl VENT PIPING TRANSITION SUMP TYPE 1.SINGLE WALL 0 2.DOUBLE WALL 90.NONE 4641 RISER PRIMARY CONTAINMENT 1 STEEL 4.FIBERGLASS 0 10.RIGID PLASTIC Lj 90.NONE Ej 99.OTHER(Spcci[y) 4641 464.1 RISER SECONDARY CONTAINMENT ❑ L STEEL 0 4.FIBERGLASS 10.RIGID PLASTIC ❑ 90.NONE 99.OTHER(Specify) 464k 464k FILL COMPONLNTS INSTALLED 1,SPILL BUCKET 8 3.STRIKER PLATE/BOTTOM PROTECTOR 0 4.CONTAINMENT SUMP 45la-c VII.UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469s CONSTRUCTION MATERIAL 1.STEEL ® 4.FIBERGLASS 0 10.RIGID PLASTIC E3 99.OTHER(Specify) 469h c VIIL CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL.ANODE(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 eDmIllilance with legal requirements APPLICANT SIGNATURE DATE 10/12/2010 470 APPLICANT NAME(print) R.C.Gossett 47 APPLICANT TiTLF. Environmental Compliance Specialist 472 UPCF UST-B-1/2 Rev.(1212007)