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c - IED PROGRAM CONSOLIDATED FORPOW UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION (One form per UST) ITYPEOFACTION (Check one item only For a UST closure or removal,complete only this section and Sections 1,11,111,IV,and IX below) I l 4 C] I NEW PERMIT F13 RENEWAL PERMIT ® ( (/5 CHANGE OF INFORMATION ❑ 6.TEMPORARY USI CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 4302 1 DATE EXISTING UST DISCOVERED: 430b 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 1 CITY 104 3202 W. Hammer Lane Stockton, CA 95209 II. TANK DESCRIPTION TANK ID# 432 TANK MANUFACTURER 433 TANK CONFIGURATION:THIS TANK IS 434 IA STAND-ALONE TANK Complete one page for each 7 !j ^a ❑ 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 ❑ ib MARINA FUELING ❑ to AVIATION FUELING 439 ❑ 3 CHEMICAL PRODUCI STORAGE ❑ 4 HAZARDOUS WASTE(includes Used Oil) ❑ 5 EMERGENCY GENERATOR FUEL[HSC§25281 5(c)] ❑ 6.OTHER GENERATOR FUEL [1 95;UNKNOWN . _...._. 99:OIHER(Specify): 439a ---.___...._...... CONTENTS PETROLEUM: ® la REGULAR UNLEADED ❑ I MIDGRADE UNLEADED ❑ Ib PREMIUM UNLEADED 440 ❑ 3 DIESEL ❑ 5 JEI FUEL ❑ 6 AVIATION GAS --...._...._ _. ❑ 8 PETROLEUM BLEND FUEL 9 OIHER PETROLEUM(Specify): 440a NON-PETROLEUM:❑ 7 USED OIL ❑ 10 ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 4aob IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1 SINGLE WALL2 DOUBLE_ ® BLE WALL ❑ 95 UNKNOWN 4433 PRIMARY CONTAINMENT ❑ 1 STEEL _ aad ® 3 FIBERGLASS ❑ 6 INTERNAL BLADDER _._-.----•-•---- 0 7:STEEL+INTERNALLINING 95.UNKNOWN [3 99 OTHER(Specify): 444a SECONDARY._. CONTAINMENT ❑ I STEEL ®3 FIBERGLASS ❑ 6 EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445 ❑ 90.NONE [_95.UNKNOWN - C3 99 OIHER(Specify): 445a OVERFILL PREVENTION ❑ lAUDIBLE&VISUAL.ALARMS [12 BALL FLOAT 3 FILL TUBE SHUT-OFF VALVE 452 ❑ 4.TANK MEEIS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQ UIPMENI V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION p I SINGLE WALL ® 2 DOUBLE WALL ❑ 99 OTHER _ 460 SYSTEM TYPE _ ,�j t PRESSURE (] 2 GRAVITY Q 3 CONVENTIONAL SUCTION ❑ 4 SAFE SUCTION[23 CCR§a636(a)(3)J ass PRIMARY CONTAINMENT C31 STEEL ® 4 FIBERGLASS ❑ 8 FLEXIBLE ❑ 10 RIGIDPLASTIC 464 ❑ 90.NONE ❑ 95 UNKNOWN ❑ 99.OTHER(Specify): 464a _._._�..._._......._.._..._..._._.__.._ 4646 SECONDARY CONTAINMENT ❑ l STEEL ® 4-F IBERGLASS ❑ 8 FLEXIBLE ❑ l0 RIGID PLASTIC .-•--_-❑ 90_NONE-- ❑ 95.UNKNOWN 99 OTHER(Specify): a6ac PIPING/TURBINE CONTAINMENT SUMP TYPE 1.SINGLE WALL ❑ 2.DOUBLE wALL ❑ 90.NONE 64a VI. VENT,VAPOR RECOVERY(VR)AND RISER f FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ 1 STEEL ® 4 FIBERGLASS [1 10 RIGID PLASTIC ❑ 90 NONE ❑ 99 OTHER(Specify): 46ae1• 464f VENT SECONDARY CONTAINMENT ❑ 1 STEEL ❑ 4 FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 90 NONE ❑ 99 OIHER(Specify): 4601 ba' VR PRIMARY CONTAINMENT ❑ 1 STEEL ® 4 FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 90 NONE ❑ 99 OIHER(Specify): 464 1. VR SECONDARY CONTAINMENT [I C11 STEEL ® 4 FIBERGLASS 10 RIGID PL ASI IC [190 NONE ❑ 99 OTHER(Specify): 4464h1. ....... ......_...._..__... ... ....---........... VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2 DOUBLE WALL ® 90 NONE aba� _... RISER PRIMARY CONTAINMENT ® 1 STEEL ❑ 4 FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 90 NONE ❑ 99 OTHER(Specify): 464j1. RISER SECONDARY CONTAINMENT El STEEL ❑ 4 FIBERGLASS ❑ 10 RIGID PLASTIC ® 90.NONE ❑ 99 OTHER(Specify)_ 466kj. ... __ . _ __...--- - .._._._.._..__... FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET 3.STRIKER PLATEIBOTTOM PROTECTOR ❑ 4.CONTAINMENT SUMP 45la-c VII. UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ® 1 SINGLE WALL ❑ 2 DOUBLE WALL ❑ 3 NO DISPENSERS Q 90 NONE 469a CONSTRUCTION MATERIAL ❑ 1 STEEL ® 4.FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 99 OTHER(Specify) 69c. VIII. CORROSION PROTECTION' STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION 448 IX. APPLICANT SIGNATURE CERTIFICATION: I certify t U sy em is patible he hazardous substance stored and that the information provided herein is true, accurat ,and in c is h I a irements. 470 APPLICANT SIGNATURE DATE APPLICANT NAME.(print) ChUCk J. OftICh 471 APPLICANT TITLE Manager of Compliance & Maint. 471 UPCF UST-B Rev.(12/2007)-1/2 www.unidocs.org