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UNDERGROUND STORAGE TANK D OPERATING PERMIT APPLICATION-TANK INFORMATION(one form per UST) ' TYPE OF ACTION (Check one item only. For an UST permanent closure or removal,complete only this section and Sections I,II,III,IV,and IX below) 430 c ® 1.NEW PERMIT ❑ 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION t ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 43oa DATE EXISTING UST DISCOVERED: 430b is Y. p`ACYLTCY II�Tl�'OR�4T$ON FACILITY ID#(Agency Use Only) BUSINESS NA (Same as FACILITY NAME or DBA-Doing Business As) ) 3 ME ARCO 02133 f"a` ^r. BUSINESS SITE ADDRESS 103 CITY toa 2908 BENJAMIN HOLT DR �y STObCKKTONy }}1 TANK ID# 1 432 TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK IS 434 Modem Welding ®1.A STAND-ALONE TANK ❑2.ONE IN A COMPARTMENTED UNIT. Complete one page for each com ailment in the unit. DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 1999/04 12 000 1 TANK USE N ]a.MOTOR VEHICLE FUELING [3 1b.MARINA FUELING ❑ lc.AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Incudes Used oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§25281.5(c)] ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 439a CONTENTS PETROLEUM: N la.REGULAR UNLEADED E3 lc.MIDGRADE UNLEADED [3 lb.PREMIUM UNLEADED 440 ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM Sec' 440a NON-PETROLEUM:❑9.USED OIL ❑ 10.ETHANOL ❑ 11.OTHERNON-PETROLEUM(SpeciW. 440b O STItUC Q TYPE OF TANK ❑ 1.SINGLE WALL ® _.DOUBLE WALL LJ95.UNKNOWN 443 PRIMARY CONTAINMENT ® 1.STEEL ❑ 3.FIBERGLASS ❑ 6,INTERNAL BLADDER 444 ❑ 7.STEEL+INTERNAL LIMING ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 444a SECONDARY CONTAINMENT ❑ 1.STEEL ❑3.FIBERGLASS ❑ 6,EXTERIOR MEMBRANE L]NER ❑ 7.JACKETED 445 ❑ 90.NONE ❑ 95.UNKNOWN N 99.OTHER(Specify): Steel Clad W/Fiberglass Reinforced Plastic 445a OVERFILL PREVENTION 1.AUDIBLE&VISUAL ALARMS N 2.BALL FLOAT ❑ 3.FILL TUBE SHUT-OFF VALVE 452• ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT PIPING CONSTRUCTION ❑1.SINGLE-WALLED N 2.DOUBLE-WALLED El99.OTHER 460 SYSTEM TYPE N 1.PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION(23 CCR§2636(a)(3)] 458 PRIMARY CONTAINMENT El1.STEEL N 4.FIBERGLASS El8.FLEXIBLE El10.RIGID PLASTIC 464 ❑ 90.NONE [195.UNKNOWN [1 99.OTHER(Specify): 464a SECONDARY CONTAINMENT ❑ 1.STEEL N 4.FIBERGLASS El &FLEXIBLE ❑ 10.RIGID PLASTIC 464b ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464e PIPING/TURBINE CONTAINMENT SUMP TYPE ® 1 SINGLE WALL ❑ 2 DOUBLE WALL ❑ 90 NONE 464 r'I. Nfi�yAF`OR RE+�QV �Y:( Aj AND RI / .II .YID 1� 1'YN COI RUC>c10]Y VENT PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464e 464e1 VENT SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC N 90.NONE ❑ 99.O THE (Specify) 4641 - 4641 VR PRIMARY CONTAINMENT ❑ 1.STEEL N 4.FIBERGLASS 0 10.RIGIDPLASTIC El 90.NONE ❑ 99.OTHER(Specify) 4648 464 1 VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS El 10.RIGID PLASTIC N 90.NONE ❑ 99.OTHER(Specify) 464h - 464ht VENT PIPING TRANSITION SUMP TYPE N ].SINGLE WALL 2.DOUBLE WALL ❑ 90.NONE 46K RISER PRIMARY CONTAINMENT N 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGIDPLASTIC Ll90.NONE [199.OTHER(Specify) 464j 464'1 RISER SECONDARY CONTAINMENT 0 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGIDPLASTIC N 90.NONE ❑ 99,OTHER(Specify) 464k 4641 FILL COMPONENTS INSTALLED N 1.SPILL BUCKET N 3.STRIKER PLATE/BOTTOM PROTECTOR N 4.CONTAINMENT SUMP 451a e UIVDLRDISPENSEII,CON'kA'INNIENT C� ` lai CONSTRUCTION TYPE ® 1.SINGLE WALL [12.DOUBLE WALL ❑ 3.NO DISPENSERS [I90.NONE 469& CONSTRUCTION MATERIAL ❑ 1.STEEL N 4.FIBERGLASS ❑ 10.RIGIDPLASTIC ❑ 99.OTHER(Specify) 469b-c VYl`i �Q�tR,QSION PROTEdTION'.• � + ' ,� ; : STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) [14.IMPRESSED CURRENT t Q 16.ISOLATION 448• - IIS APPLICANT SYGNA CERTIFICATION:I certify that this UST sys ompatible with the hazardous substance stored and that the information provided herein is true,accurate, and in full compliance Wfiblegal requirements. APPLICANT SIGNATURE DATE 470' � D APPLICANT NAME(print) BRA ASAGOITIA 471. APPLICANT TITLE Environme talComplianceSpecialist 472' I i UPCF UST-A Rev.(12/2007) F i