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L13.(b UNIFIED PROGRAM CONSOLIDA'T'ED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION (One form per UST) '1'1'1'1'-:OF,\C'ITON 1Check one item onh Foran I ISI'permanent closure or removal.complett onh this section mId Szctiau I.II.TIL IV,and IX below) ❑ I NGW PERMIT ❑ 3 RL•NEWAL PERMIT ❑ 5 CHANGE'OF INFORMA IION 6 1-EhLPORARY UST CLOSURE ® 7.UST PERMANENT CLOSURE ON SITE Cj 11.UST RFMOVAI. DATE USTPERC'LOSf;D' �2/31/ZO1 O 4104 DATE EXISTING UST DISCOVERED 430b 1. FACILITY INFORMATION FACILITY ID#(agency Use Orth/ s� I BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) ARCO#06080 BUSINESS SITE ADDRESS 103 CITY Ino 85 East Lousie Avenue Lathrop 11.TANK DESCRIPTION TANK ID# 3 432 TANK MANUFACTURER 433 TANK CONFIGURATION: Ti IIS TANK IS 434 Owens Corning ® I.A STAND-ALONE TANK _O ❑2.ONE IN A C'OMPARTmENTED UNIT. (Q Coni fete one page for each cont nment in the unit. DATE US SYSTEM INSTALLED 435 TANK CAPACITY 1N GALI.ONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 1984/10 12,000 1 III.TANK USE AND CONTENTS TANK USE ® Is,MOTOR VEHICLE FUELING ❑ I b.MARINA FUELING ❑ Ic AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HA7ARDOUS WASTE(Includes Used Oil) ❑ 5 EMERGENCY GENERATOR FUEL(fisc§+'25281 5(c)1 ❑ k OTI IFR GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99 OTHER (Speci ): 439a CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ® Ib.PREMIUM UNLEADED 440 ❑ 3.DIESEL ❑ 5..IET FUEL ❑ 6 AVIATION GAS ❑ 8 PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM (S ecifv): 440a NON-PETROLEUM:❑ 7 USED OIL ❑ 10.ETHANOL ❑ I I OTHER NON-PETROLEUM(Specify): 440b IV. TANK CONSTRUCTION TYPE OF TANK 0 1.SINGLE WALL 2.DOUBLE WALL 0 95.UNKNOWN 443 PRIMARY CONTAINMENT ❑ 1.STEEL ® 3 FIBERGLASS Q 6.IN'T'ERNAL BLADDER 444 ❑ 7,STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER I (Specify): 444a SECONDARY CONTAINMENT 1.STEEL 3.FIBERGLASS 6.PXTERIOR MEMBRANE LINER Ll 7.JACKETED 445 ❑ 90.NONE 95-UNKNOWN ❑99,OTHER(5 i ): 445a OVERFILL PREVENTION 1.AUDIBLE&VISUAL ALARMS ® 2.BALL FLOAT 3 FILL TUBE SHUT-OFF VALVE 452 ❑ 4.TANK MEETS REQUIREMENT'S FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION I SINGI.&WAI.I.F.D 2.DOUBLE-WALLED 99:OTHER 460 SYSTEM TYPE ❑ 1 PRESSURE El 2.GRAVITY 3.CONVENTIONAL SUCTION ❑ 4 SAFE SUCTION CCR fMJ6(sX3)j 458 PRIMARY CONTAINMENT I,STF.F.I. ❑ 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10 RIGID PLASTIC 464 ❑ 90.NONE ❑ 95,UNKNOWN ❑ 99,OTHER ity: 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.DOTJBLF.WALT. ❑ 90.NONE 4644 Vl.VENT, VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT I.STEEL 4,FIBERGLASS 10.RIGID PLASTIC 0 90 NONE 0 99.OTHER(Specify) 4646 464e1 VENT SECONDARY CONTAINMENT 0 I,STEEL 4,FIBERGLASS ❑ 10.RIGID PLASTIC 90 NON[ 0 99.OTHER(Specify) 4641' 4641'1 VR PRIMARY CONTAINMENT ❑ 1.STEEL 0 4.FIBERGLASS 0 10.RIGID PLASTIC ❑ 90 NONL 99.OTHER(Specify) 4648 464ti VR SECONDARY CONTAINMENT ❑ I.STEEL 4.FIBERGLASS 0 10.RIGID PLASTIC 90 NONF. 99.OTHER(Spacify) 464h 464h1 VENT PIPING TRANSITION SUMP TYPE 1.SINGLFWALL ❑ 2.DOUBLE WALL 0 90 NONE 4641 RISER PRIMARY CONTAINMENT i,STEEL 4.FIBERGLASS Fj 10 RIGID PLASTIC El 90 NONE: 0 99 OTHER(Specify) 4" 4e4 t RISER SECONDARY CONTAINMENT I.STEEL 0 4 FIBERGLASS 10.RIGID PLASTIC 90.NONE E3 99.OTHER(Specify) 464k "I FILL COMPONENTS INSTALLED 1.SPILL BUCKET 3.STRIKER Pt.ATF/BOTTOM PROTECTOR 4 CONTAINMENT SUMP 4Sia-c VII. UNDER DISPENSER CONTAINMENT(UAC) CONSTRUCTION TYPE ❑ 1.SINGLE WALL ❑ 2 DOUBLE WALL ❑ 3 NO DISPENSERS ❑ 90.NONE 469a CONSTRUCTION MATERIAL ❑ I.STEEL ❑ 4 FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 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: 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 SIGNATUREDATE- 10/12/2010 "° APPLICANT NAME(print) R.C.Gossett 471 APPLICANT TITLE Environmental Compliance Specialist 17, UPCF UST-B-1/2 Rev.(12/2(1(17)