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Alk UW. IED PROGRAM CONSOLIDATED FOR c, UNDERGROUND STORAGE TANK / tx 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 1,11,/[/,IV,and IX below) 1/n �y f �0 ❑ I NEW PERMIT ❑ 3 RENEWAL PERMIT ® 5 CHANGE.OF INFORMATION LCA -LJ49 1 ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DATE.UST PERMANENTLY CLOSED: 430a I DATE EXISTING UST DISCOVERED: 430b I. FACILITY INFORMATION - FACILITY ID#(Agency Use Only) 1311 -7 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 Stockton, CA 95209 II. TANK DESCRIPTION TANK ID# 432 TANK MANUFACTURER 433 TANK CONFIGURATION:THIS TANK IS 434 yA I A STAND-ALONE TANK Complete one page for each Lj 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 P III. TANK USE-AND CONTENTS TANK USE ® la MOTOR VEHICLE FUELING ❑ lb MARINA FUELING ❑ 1c AVIATION FUELING 439 ❑ 3 CHEMICAL PRODUCT STORAGE ❑ 4 HAZARDOUS WASIE(Includes Used Oil) ❑ 5 EMERGENCY GENERATOR FUEL[HSC§252815(c)) ❑ 6.OTHER GENERAIOR FUEL ❑ 95 UNKNOWN _.. _................_....._ 0 99:OTHER(Specify): 439a ___._.__............ CONTENTS PETROLEUM: ❑ la REGULAR UNLEADED ❑ Ic MIDGRADE UNLEADED ® lb PREMIUM UNLEADED 440 ❑ 3 DIESEL ❑ 5 JEI 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 ❑ l SINGLE WALL ® 2.DOUBLE WALL ❑ 95.UNKNOWN 443 _...._ _ .. _,....._. ........ .........._...---_....._....._...._. __.. ... _............ _._...... PRIMARY CONTAINMENT ❑ 1.STEEL ® 3 FIBERGLASS ❑ 6 INTERNAL BLADDER 7 STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99 OTHER(Specify): 444a ❑ �._I'.. y� SECONDARY CONTAINMENT ❑ 1 STEEL 03 FIBERGLASS ❑ 6 EXTERIOR MEMBRANE LINER ❑ 7 JACKETED aas _ ❑ 90.NONE ❑ 95.UNKNOWN ❑99 OIHER(Specify): 445a ---�--.. . .__.. . ... .... - ..,...._..-...__.._.... .. ... ..-.-----.._...__ .. ._._.. .._ .---_....._.....__.._.,... 452 OVERFILL PREVENTION ❑ 1 AUDIBLE&VISUAL ALARMS [12 BALL FLOAT 3 FILL TUBE SHUT-OFF VALVE ❑ 4.TANK MEETS RE UIREMENIS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRQI}UCT.0 WASTE TYPING,CONSTRUCTION PIPING CONSTRUCTION ❑ L SINGLE WALL ® 2.DOUBLE WALL ❑ 99.OTHER 460 ---- ---- .. ..._ .... ...... ....._....._._..-- -- - __ ...._..- ..._._ - - SYSTEM.TYPE....__ - ,le I.PRESSURE ❑ 2 GRAVITY ❑ 3.CONVENTIONAL SUCTION [34.SAFE SUCTION[23 CCR§2636(ax3)] 458 IM PRARY CONTAINMENT ❑ l STEEL ® 4 FIBERGLASS ❑ 8 FLEXIBLE ❑ 10 RIGID PLASTIC 464 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464a ----....--�----_..._.__._-_.................._ ......._ ._. -------- .. SECONDARY CONTAINMENT ❑ I STE..EL ® 4 FIBERGLASS ❑ 8 FLEXIBLE ❑ 10 RIGID PLASTIC 4646 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c PIPING/TURBINE CONTAINMENT SUMP TYPE J1 I.sINGLE_W"'ALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464E VI. VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT I STEEL ® 4 FIBERGLASS ❑ 10 RIGID PLASTIC [190 NONE El 99 OTHER(Specify): 464e1 [j VENT SECONDARY CONTAINMENT ❑ 1 STEEL ❑ 4.FIBERGLASS ❑ 10 RIGID PL.ASI[C ❑ 90 NONE ❑ 99 OTHER(Specify): 464f1 ---- ----.._._--._......._._..... ............. .. .. ....... __.....__. __ _.. - _.. .. .. _... ._.... ... .. ....._ _.. 4�. VR PRIMARY CONTAINMENT ❑ 1 STEEL 04.FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 90 NONE ❑ 99 OTHER(Specify): 464 1 VR SECONDARY CONTAINMENT' ❑ 1 STEEL ® 4 FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 90 NONE ❑ 99 OTHER(Specify): 464h _. .. ...... ....... ......... ... ..... . ...... .................... .._. _.._ ....... .. ..._.. .. .. ... ...464i VENT PIPING TRANSITION SUMP TYPE ❑ 1 SINGLE WALL ❑ 2 DOUBLE WALL ® 90 NONE .. ... ._... .- .._.. .__.. ._._. 464j RISER PRIMARY CONTAINMENT ® 1 STEEL ❑ 4 FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 90.NONE ❑ 99.OIHER(Specify):- a6aj1., ....... ........_ .....___...._. ....._ ..._ .. - ... _. ... ...._ 464k RISER SECONDARY CONTAINMENT ❑ 1 STEEL ❑ 4 FIBERGLASS ❑ 10 RIGID PLASTIC ® 90.NONE ❑ 99 OTHER(Specify): 464k1. _...._....._._..._.... _........... . _ --..... ........------ - --...----.. ..._..._........._........_..............-....._....._._- -- - ...._.._• FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET 3.STRIKER PLATE/BOTTOM PROTECTOR ❑ 4.CONTAINMENT SUMP a-c VII: UNDER DISPENSER''CONTAINMENT (UDC) CONSTRUCTION TYPE ® I SINGLE WALL ❑ 2.DOUBLE WALL ❑ 3 NO DISPENSERS ❑ 90.NONE 469a - --- __ .. ._.......... - -- -- --. _ 6§6 CONSTRUCTION MATERIAL ❑ I STEEL ® 4 FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 99.OTHER(Specify) 44v9c. VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION 448. IX. APPLICANT SIGNATURE CERTIFICATION: I certify t this US s m is alible w' a hazardous substance stored and that the information provided herein is true, accur e,an in full lianc i al rtqWments. APPLICANT SIGNATU - DATE / 470 APPLICANT NAME(print Chuck ch 471 APPLICANT TITLE Manager of Compliance &Maint. 472 J. l UPCF UST-13 Rev.(12/2007)-1/2 www.unidoes.org