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UNIFIED PROGRAM CONSOLIDATED FORM t" UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION (one per UST) TYPE OF ACTION (Check one item only. For a UST closure or removal,complete only this section and Sections 1,11,111,IV,and IX below) r t �- / 430. ❑ 1.NEW PERMIT ❑ 3.RENEWAL PERMIT ® 5.CHANGE OF INFORMATION G ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL 31;_y DATE UST PERMANENTLY CLOSED: 430- 1 DATE EXISTING UST DISCOVERED: 43ob. I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) v 1. BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3. CRLLC/76#5448 BUSINESS SITE ADDRESS 103. CITY 104. 3202 W. Hammer Lane Stockton II. TANK DESCRIPTION TANK ID# --11/1 . ; _ T:5,432.4TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434. r 1 Unknown ® LA STAND-ALONE TANK Complete one page for each ❑ 2.ONE IN A COMPARTMENTED UNIT compartment in the wit. DATE UST SYSTEM INSTALLED 435. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS IN THE UNIT 437. 12/19/1998 10,008 III. TANK USE AND CONTENTS TANK USE ® la.MOTOR VEHICLE FUELING ❑ lb.MARINA FUELING ❑ lc.AVIATION FUELING 439. ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) [1 5.EMERGENCY GENERATOR FUEL IHSC§25281.5(c)] ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 439& CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ❑ Ib.PREMIUM UNLEADED 440. ® 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ... ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM(Specify): "Oa. NON-PETROLEUM.❑ 7.USED OIL _. _.__...... -....__.. ❑ 10.ETHANOL ......... ..... ❑ 11.OTHER NON-PETROLEUM S eci : 440b. IV. TANK CONSTRUCTION TYPE OF TANK ❑ L SINGLE WALL-® 2 DOUBLE WALL [195.UNKNOWN _ 44 --- - PRIMARY CONTAINMENT ❑ 1.STEEL ® 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444. .....................__._....._-____._....._......_._._-._____..._...._ _..7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 444& SECONDARY CONTAINMENT ❑ 1.STEEL ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445. ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER .........--------- ........... . .. .._........._. OVERFILL PREVENTION ❑ 1.AUDIBLE&VISUAL ALARMS ❑ 2.BALL FLOAT ❑ 3.FILL TUBE SHUT-OFF VALVE 452. ® 4.TANK MEETS RE UIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V: PRODUCT;./WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ 1 SINGLE WALL ❑ 2_DOUBLE WALL 99.OTHER 460. ..- ..... ..... - SYSTEM TYPE ❑ I.PRESSURE ❑ 2.-GRAVITY ❑ 3 CONVENTIONAL SUCTION ❑ 4 SAFE SUCTION_ [23 CCR§2636(a)(3)] 458. PRIMARY CONTAINMENT ® 4.FIBERGLASS ❑ 8.FLEXIBLE 464. ❑ 1.STEEL ❑ ]0.RIGID PLASTIC [:1 NONE ❑ 95._PNKNOWN ❑ 99.OTHER(Specify): 464& _........_.....-.........._...._............. --._..._.... - ------ -- --._..._...__..._...._..---- . - ........................_...._.._........_...._.._....--_..._...._._....._._..- ..... -- SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464b. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c. --- . . .. __._....... . .............. . ..- -- - PIPING/I'URBINE 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 ❑ L STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE [199.OTHER(S ci 464e. - �) 464el. VENT SECONDARY CONTAINMENT ❑ 1 STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 4641714 VR ---- - VR PRIMARY CONTAINMENT _._ ._... .. .............. 46ag. ❑ .. STEEL ❑ 4.FIBERGLASS ❑ l0 RIGID PLASTIC . 90 NONE ❑ 99.OTHER.Specify): 4641 VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE [1 99. (Specify): 464E 464hl. VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE 4641. _..__.- . ..._._...._._.__. .._......_.- _.._._...... _....... ..... ............ _............. _.__....... ....-- _.._... _... ... .....-..... ................ RISER PRIMARY CONTAINMENT ❑ 1 STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99 OTHER(Specify): q46 j RISER SECONDARY CONTAINMENT ❑ 1.STEEL -❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 46441. FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET ❑ 3.STRIKER PLATE/BOTTOM PROTECTOR ❑ 4.CONTAINMENT SUMP 451a-c. VII. UNDER DISPENSER:.CONTAINMENT(UDC) CONSTRUCTION TYPE ❑ 1 SINGLE WALL [12 DOUBLE WALL ® 3 NO DISPENSERS ❑-9.0 NONE 469a - ------ - CONSTRUCTION MATERIAL ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 469b. 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 SIGNATURE "39 DATE "]/ azo. APPLICANT NAME(print) Allen FaaSS 471. APPLICANT TLE California Compliance Manager 472 UPCF UST-B Rev.(12/2007)-1/2 www.unidocs.org