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UNIFIED PROGRAM CONSOLIDATED FORM r 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,A 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: 430a. 1 DATE EXISTING UST DISCOVERED: 430b. I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) '0 1 r BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3. CRLLC#2705448 BUSINESS SITE ADDRESS 103. CITY 104. 3202 W. Hammer Lane Stockton II. TANK DESCRIPTION TANK ID# . - 432. TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434. ® 1.A STAND-ALONE TANK Complete one page for each Unknown ❑ 2.ONE IN A COMPARTMENTED UNIT compartment in the unit. DATE UST SYSTEM INSTALLED 435. TANK CAPACITY IN GALLONS 436. NUMBER OF C MPARTMENTS IN THE UNIT 437. 12/19/1998 10,008 III. TANK USE AND CONTENTS TANK USE ID la.MOTOR VEHICLE FUELING ❑ lb.MARINA FUELING ❑ Ic.AVIATION FUELING 439. ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§25281.5(c)l ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 439a. ..... ... _ ........... _...,__... 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): 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 ❑ I.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 452. 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ 1.SINGLE WALL 2.DOUBLE WALL ❑ 99.OTHER 460. SYSTEM TYPE �7 PRESSURE ❑ 2.GRAVITY � 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR§2636(ax3)1 458. PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464a. _.._. _. _...._. _.. _....._ _... .. ......... .. -- - ..... .._....... SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 4646. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c. ......... .. ............. _....._. . ......_........ .. ......- PIPING/TURBINE CONTAINMENT SUMP TYPE .SINGLE WALL ❑ 2.DOUBLE WALL COOO.NONE 464d. VI. VENT,VAPOR RECO RY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT E] 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE [1 99.99.OTHER(Speci 464e. 464e1. VENT SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 464fl -9 _. VR PRIMARY CONTAINMENT ❑ 1.STEEL _R'4 FIBERGLASS ❑ 10.RIGID PLASTIC �o.NONE ❑ 99 OTHER(Specify): 461&1 ........ ....... .... _..__ - ---- VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify):------------ 464h. VR _....._.....__..._......_._._._....- . __...__._..._...__....._....._...._._..._.....__.._. ....---__....._....__...._......_......_.....__..._....._...__......__..._....._....._....._.._..._......_...._._._...._.._..........................._._......_._..__....__..._.............-.....__....__............. _..,_... VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE 4C i. _. - _._...... ... .......... ... .......... RISER PRIMARY CONTAINMENT STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC 90.NONE El 99.OTHER(Specify): 464 l _ __�._ _.��__... __....._....._......_.. .....__. �..... __. _.r __... ....._....._.....__.. ... �..�... ..._..._... RISER SECONDARY CONTAINMENT ❑ 1.STEEL C] 4.FIBERGLASS ❑ 10.RIGID PLASTIC _® 90.NONE [199.OTHER(Specify): 464k1. FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET ,3.STRIKER PLATEBOTTOM PROTECTOR ❑ 4.CONTAINMENT SUMP 451ac. VII. UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE 1.SINGLE WALL 469& _.......,___.......__.... ..._......._............._....__....__...__..._........_......._.._.....__ - _..__.__.._._. . ... _ ❑_2.DOUBLE WALL 3.NO DISPENSERS ❑ 90.NONE 4696. CONSTRUCTION MATERIAL1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 469c. VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODES ❑ 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 11 com lhmc I requirements. APPLICANT SIGNATURE DATE 470. APPLICANT NAME(print) Armen Mkrtychlan 471' APPLICANT TITLE California Compliance Manager 42 UPCF UST-B Rev.(12/2007)-1/2 www.unidocs.org