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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK � OPERATING PERMIT APPLICATION-TANK INFORMATION '(One form per UST)' TYPE OF ACTION (Check one item only. For a UST closure or removal,complete only this section and Sections I,11,III,IV,and IX below) 430. ❑ 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: 4304 1 DATE EXISTING UST DISCOVERED: 4306. I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) 1 BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3. CRLLC #2705448 BUSINESS SITE ADDRESS 103. CITY 104. 3202 W. Hammer Lane I Stockton II. TANK DESCRIPTION TANK ID# -r ,� 432. TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434. 1 Unknown ® 1.A STAND-ALONE TANK Complete one page for each ❑ 2.ONE IN A COMPARTMENTED UNIT compartment in the unit. 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) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§25281.5(c)] ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 439x. CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED ❑ la MIDGRADE UNLEADED ❑ Ib.PREMIUM UNLEADED 440 ® 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM(Specify): 440a. NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 4406. 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): 444a- _...._ .... _..--_. ..__._- _ SECONDARY CONTAINMENT ❑ 1.STEEL ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445. ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specify): 445a. OVERFILL PREVENTION ❑ 1.AUDIBLE&VISUAL ALARMS ❑ 2.BALL FLOAT 3.FILL TUBE SHUT-OFF VALVE asz. ar_4.TANK MEETS REQUIREMENT§FOR EXEMPTION FROM OVERF LCPREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ 1.SINGLE WALL 2.DOUBLE WALL ❑ 99.OTHER 460. SYSTEM TYPE , 1.PRESSURE ❑ 2 GRAVITY ❑ 3 CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR 42636(ax3)] 1458. PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464a. SECONDARY CONTAINMENT 011-STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC .11 1464b. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 4644 __............. ........_ ... ...... ..... PIPING/TURBINE CONTAINMENT SUMP TYPE 1.SINGLE WALL ❑ 2.DOUBLE WALL t`-0.NONE 464d. VI. VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ 1.STEEL N 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 4�el _..._. _.......... ..... ... ..._......_ . . .............. .........._.. .__.__ 464f. VENT SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 464fl. _..... __ ...._.... _ _..... -... -- _... _ _. _..... _.. _.._ VR PRIMARY CONTAINMENT ❑ 1.STEEL �4_FIBERGLASS ❑ 10 RIGID PLASTIC 0 NONE ❑ 99 OTHER(Specify): 1446 ... _-... _ _. _ _ ._.. .._...__... ._.._-._ _ _.. 464h. VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 464h1 _...__......_....._......_......_.__..._..._.. - .._...._......_..... --------._..__..._....._..._........_....._....._..- _.....__....__.....__..._......-__...__.._...._....._._--___...__....__....._......_............._....__....._...._....._......_.._.-_....__......_............. -- VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE 14641. RISER PRIMARY CONTAINMENT 1 STEEL ❑ 4 FIBERGLASS ❑ 10.RIGID PLASTIC *-,90 NONE ❑ 99 OTHER(Specify) 464 l RISER SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 464kl. _.....-...__..._._-...__.._...-.._... ...__..._....._..._.... ._....... _...__..__.___ ___�..._.._..._...._.__...._....._....._.....-................_....._..... ®_.._.__..._.._._ FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET 3.STRIKER PLATE/BOTTOM PROTECTOR ❑ 4.CONTAINMENT SUMP 451ac. VII. UNDER DISfPtNSER CONTAINMENT(UDC) CONSTRUCTION TYPE 1.SINGLE WALL 2.Dr-11 469a. ................._....._..__......_._..........._......_.......__.....__....._.___....__......__...._.._.--- .....__..._...._._.._..__...__........_......__...__....._.._........._. ❑ DOUBLE WALL NO DISPENSERS ❑ 90.NONE CONSTRUCTION MATERIAL 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 4696 VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODES ❑ 4.IMPRESSED CURRENT Ik.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,a n full com a al requirements. APPLICANT SIGNATURE DATE 05 470' APPLICANT NAME(print) Armen Mkrtyclllan 471' APPLICANT TITLE California Compliance Manager 472 UPCF UST-B Rev.(12/2007)-1/2 www.unidocs.org