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UNIFIED PROGRAM CONSOLIDATED FORM -�`t ! '( <br /> UNDERGROUND STORAGE TANK ., <br /> OPERATING PERMIT APPLICATION-TANK INFORMATIN (One form per US1 f' <br /> TYPE OF ACTION (Check one item only. For a UST closure or removal,complete only this section and Sections I,A III,IV,and IX below) 430. <br /> ❑ 1.NEW PERMIT ❑ 3.RENEWAL PERMIT ® 5.CHANGE OF INFORMATION <br /> ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL <br /> DATE UST PERMANENTLY CLOSED: 430- DATE EXISTING UST DISCOVERED: 430b. <br /> �r I IF LI 'Y INFOR 'A PION . <br /> FACILITY ID#(Agency Use Only) 3, <br /> BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3. <br /> CRLLC/76#5448 <br /> BUSINESS SITE ADDRESS 103. CITY 104. <br /> 3202 W. Hammer Lane Stockton <br /> IJP. <br /> TAN DESCR 'TIbN <br /> TANK ID# �,_ / / 432. TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434. <br /> � .�� <br /> 3 Unknown ® 1.A STAND-ALONE TANK Complete one page for each <br /> ❑ 2.ONE IN A COMPARTMENTED UNIT comparnnent in the unit. <br /> DATE UST SYSTEM INSTALLED 435. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS IN THE UNIT 437, <br /> 12/19/1998 10,008 <br /> III, T.�1�1K` JSE ANI? CONTENTS <br /> TANK USE ® Ia.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ Ic.AVIATION FUELING X439. <br /> ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§25281.5(c)] <br /> ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 439& <br /> CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED ❑ lc.MIDGRADE UNLEADED ® lb.PREMIUM UNLEADED 440. <br /> ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS <br /> ❑ 8.PETROLEUM BLEND FUEL Q 9 OTHER PETROLEUM(Specify)_ 440- <br /> __UM __...... -- ......_.._ _.... ...__.._..... <br /> NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL <br /> ❑ 11.OTHER NON-PETROLEUM(Specify): 440b. <br /> IV.;TANK C %7QLv :. <br /> TYPE OF TANK ❑ 1 SINGLE WALL ® 2:DOUBLE WALL ❑ 95.UNKNOWN 443. <br /> PRIMARY CONTAINMENT ❑ L STEEL ® 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444. <br /> __._._.._....._.._........_._....._.._......._...._._____-_._❑ 7_STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTH­11111111ER(S_pecify): 444a <br /> SECONDARY CONTAINMENT ❑ 1.STEEL ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445. <br /> ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specify): 445a <br /> OVERFILL PREVENTION ❑ 1.AUDIBLE&VISUAL ALARMS ❑ 2.BALL FLOAT ❑ 3.FILL TUBE SHUT-OFF VALVE 452. <br /> ® 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT <br /> PR011LTCT/WASTE PIPING CONSTRUCTION <br /> PIPING CONSTRUCTION ❑ 1.SINGLE WALL ❑ 2_DOUBLE WALL ❑ 99 OTHER 460. <br /> _ _ . ..._..... . <br /> .._.. -------. .__..4... <br /> SYSTEM TYPE ❑ 1 PRESSURE ❑ 2 GRAVITY ❑ 3 CONVENTIONAL SUCTION ❑ 4_SAFE SUCTION(23 CCR§2636(a)(3)] 58. <br /> PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464. <br /> ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify)_ 464x. <br /> SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464b. <br /> ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify) 464c. <br /> _: <br /> (Specify)--------I—- _ <br /> PIPING/TURBINE CONTAINMENT SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE 464d. <br /> VI. VENT,VA,, RECOVERY(VR)AND RISER L.FitlG PIPE PIPING '"'NST 7CTIf I <br /> VENT PRIMARY CONTAINMENT ❑ 1 STEEL ® 4.FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 90.NONE ❑ 99 OTHER(Specify): 46641. <br /> .. _... . _.. ..... -.._......._ ... . ...... _._. .. ....... <br /> VENT SECONDARY CONTAINMENT ❑ I STEEL ® 4 FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90:NONE ❑ 99.OTHER(Specify): 4 4f <br /> --1.1 ............ __.-.-. ..................... ___._ -- <br /> VR PRIMARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS -464g. <br /> ❑ 10 RIGID PLASTIC ® 90 NONE ❑ 99.OTHER(Specify): 466 1 <br /> VR SECONDARY CONTAINMENT ❑ 1 STEEL ❑ 4.FIBERGLASS ❑ 10 RIGID PLASTIC ® 90 NONE ❑ 99.OTHER(Specify): 6464. <br /> _... .. ._._.. -.-.__ ..... --- .-.... . ..... _.__.. _...._.. <br /> VENT PIPING TRANSITION SUMP TYPE ❑ I.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE 4641. <br /> _._. _...- ...... .- _...... _.__..... _......._. _. ... .......... .. ......... . <br /> RISER PRIMARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER 4641. <br /> _ (Specify): 4641. <br /> RISER SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 464 <br /> 464k. <br /> 64. <br /> FILL COMPONENTS INSTALLED _�- - " <br /> ® 1.SPILL BUCKET ❑ 33.S�T�RIKER�P^+LATEBOTTOM PROTECTOR ❑ 4.CONTAINMENT SUMP 45la-c. <br /> UNLIEJ L DISPENSER":4ONTA N NTa, �C . <br /> CONSTRUCTION TYPE <br /> _ , ....-__._.. __-_ ❑ 1 SINGLE WALL ❑ .. DOUBLE WALL ® 3_NO DISPENSERS 469a <br /> ----- __..---. _� 90.NONE _ _-- <br /> CONSTRUCTION MATERIAL ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER4696. <br /> (Specify) 469c. <br /> 6 tfiIII.;COR (ISIOI T,PR+pTE TI'0 <br /> STEEL COMPONENT PROTECTION [:12.SACRIFICIAL ANODES [14.IMPRESSED CURRENT ❑ 6.ISOLATION 448. <br /> 1APPI,ICAN ' �ITATU ' <br /> CERTIFICATION: I certify that this UST system is compatible with the hazardous substance stored and that the information provided herein is true,~ <br /> accurate and in full compliance with legal requirements. <br /> APPLICANT SIGNATURE DATE 474. <br /> APPLICANT NAME(print) Allen FaaSS 471. APPLICANT TLE California Compliance Manager 472. <br /> UPCF UST-B Rev.(12/2007)-1/2 www.unidocs.org <br />