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Q( UTWIED PROGRAM CONSOLIDATED FOR � S 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) 430 ❑ I NEW PERMIT ❑ 3 RENEWAL PERMIT ® 5 CHANGE OF INFORMATION D ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL j DATE UST PERMANENTLY CLOSED: 430a I DATE EXISTING UST DISCOVERED: a3o I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) - - r -) I I 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 ,tt,1.A STAND-ALONE TANK Complete one page for each C' t 5 ❑ 2.ONE IN A COMPARIMENTED UNII 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 ❑ Ic AVIATION FUELING 439 ❑ 3 CHEMICAL PRODUCT STORAGE ❑ 4 HAZARDOUS WASTE(Includes Used oil) ❑ 5 EMERGENCY GENERA IOR FUEL[HSC§25281 5(c)] ❑-6.OIHER GENERATOR FUEL _ _ [ 95.UNKNOWN _......._.._..____._ [199.OTHER(Specify): 439a CONTENTS PETROLEUM:-...... R❑ la EGULAR UNLEADED ❑ I MIDGRADE UNLEADED ❑ 1b PREMIUM UNLEADED 440 ® 3 DIESEL ❑ 5 .JET FUEL ❑ 6 AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM(Specify): a4oa .------ -....._._..-........•----._. - .._.. -- ......_......- ._........ ........... NON-PETROLEUM:❑ 7 USED OIL ❑ 10 ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 440b IV. ,TANK CONSTRUCTION TYPE OF TANK - D 1 SINGLE WALL ® 2.DOUBLE WALL_ [1 95,UNKNOWN 443 PRIMARY CONTAINMENT 0 1 STEEL ® 3 FIBERGLASS ❑ 6 INTERNAL_ BLADDER 4'44 ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99 OTHER(Specify): 444a SECONDARY CONTAINMENT [3I STEEL ®3 FIBERGLASS ❑ 6 EXTERIOR MEMBRANE LINER ❑ 7 JACKETED 445 E] 90.NONE ❑ 95.UNKNOW_N_ ❑9_9 OIHER(Specify): 445a OVERFILL PREVENTION ❑ 1 AUDIBLE&VISUAL ALARMS- ❑ 2 BALL FLOAT 3 FILL TUBE SHUT-OFF VALVE 452 ❑ 4.IANK MEETS REQUIREMENT S FOR EXEMPTION FROM OVERT I L PREVENIION E UIPMENI V. PRODUCT f'�?KASTE PIPING;CONSTRUCTION PIPING CONSTRUCTI.ON_ ❑ I.SINGLE WALL ® 2 DOUBLE WALL ❑ 99 OTHER 460 .........-..... -- SYSTEM TYPE 1 PRESSURE ❑ 2.GRAVITY ❑ 3 CONVENTIONAL SUCTION ❑ 4 SAFE SUCTION 123 CCR§2636(ax3)1 458 PRIMARY CONTAINMENT ❑ 1 STEEL ® 4 FIBERGLASS ❑ 8 FLEXIBLE ❑ l0 RIGID PLASTIC 464 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464a. -------._..............._.....___...._..._..... ._- ----'---- ... ..__ _.._-......_._._.....__.._.. ... -4646 SECONDARY CONTAINMENT ❑ 1 STEEL ® 4 FIBERGLASS ❑ 8 FLEXIBLE ❑ 10 RIGIDPLASTIC ❑_ 90.NONE [195.UNKNOWN [I99.OTHER(Specify): 464c PIPING/TURBINE CONYP CONTAINMENT SUMP TE I. slNciE wAL't, ❑ z.DOUBLE WALL ❑ 90.NONE 464d VI. VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ L STEEL ® 4 FIBERGLASS ❑ 10 RIGID PLASIIC ❑ 90 NONE ❑ 99 OTHER(Specify): 46oi. ..._ _. _ _..... __ _. _-..... "_. VENT SECONDARY CONTAINMENT ❑ ].STEEL [14.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90 NONE El 99 OIHER(Specify): 464fl 4640 VR PRIMARY CONTAINMENT ❑ I STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90 NONE ❑ 99 OIHER(Specify): 4yy�l _ - - VR SECONDARY CONTAINMENT ❑ I STEEL ® 4 FIBERGLASS ❑ 10 RIGID PLASIIC El90 NONE [199 OTHER(Specify): 46gj ....._.............. _ __. 464i: VENT PIPING TRANSITION SUMP TYPE ❑ I SINGLE WALL ❑ 2 DOUBLE WALL ® 90 NONE RISER PRIMARY CONTAINMENT ® 1 STEEL ❑ 4 FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 90 NONE ❑ 99 OTHER(Specify): 44 RISER SECONDARY CONTAINMENT [I1 STEEL [14.FIBERGLASS [1 10 RIGID PLASTIC ® 90 NONE ❑ 99 OTHER(Specify): 464kkI _.__................._...._..._........_.__.... FILL COMPONENTS INSTALLED ® I.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 [1 90,NONE 469a .__ .. ___....._......... ....... ... - 4696 CONSTRUCTION MATERIAL ❑ 1 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 cerd t syste compatib the hazardous substance stored and that the information provided herein is true, accu te.an com i' with I rfAeTrements. APPLICANT SIGNAT DAIE. ��/�j� 470 APPLICANT NAME(print) ChUC , . Softich 4" APPLICANT TITLE Manager of Compliance & Maint. 412 UPCF UST-B Rev.(12/2007)-1/2 www.unidocs.org