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0 <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> UNDERGROUND STORAGE TANK <br /> OPERATING PERMIT APPLICATION —TANK INFORMATION (Onc form Per USF) <br /> TYPE OF ACTION (Check one(tear arlp. For a C=S7 closure or re naval,cwnplete only this section and Sections 1 1L III. 11' and LV heloif:j 4.6 <br /> ❑ 1 NEW PERMIT ❑ 3_RENEWAL PERMIT ® 5.CHANGE OF INFORMATION <br /> ❑ 6 F E:MPORARY US-1 CLOSURE ❑ T 1 IST PERII.ANENT C L OSURE ON SITZ: 8 LIS 1 RLMOV'AL. �� <br /> DAI S LS'F PLKMANEN I LY C'LOSf D 4. a DATE EXISTING I ST DISCOVERFI) <br /> L FACILITY INFORMATION <br /> FACILITY ID#i I eng 1._re OWY) � ) <br /> I <br /> BL'StNESS NAME/Same ns Fncilitr:Varve or DR,I- DoinQ Raciness As) <br /> USA/Tesoro 68152 <br /> BI'SINF.SS SITE:ADDRESS - +' cl-1-Y — IN <br /> 401 W. Kettleman Lane Lodi <br /> j— ll. TANK DESCRIPTION <br /> 'LANK ID# 43_ i FANK MANUFACTURER 433 � TANK CONFIGURATION:TEAS TANK IS <br /> • `���� �� 1'CUSCO ❑ I AS(AND ALONETANK (—FICmonepagel-reach <br /> ❑ ? ONL IN.� l)MPART MENTED UNI �nn'Ranmam;n the nit. <br /> DATE UST SYSTEM INS I ALLED TANK CAPACITY IN GALLONS 4-c NUMBER OF C OMPAR FMENIS IN F HE UNFF 1}7 <br /> 1998 <br /> i 14.000 I � <br /> III. TAN_K USE AND CONTENTS <br /> TANK USE ® la MOIOR VI:-,HICLE F1'FI_INC, --(] lb MARINA FUELING ❑ Ic.AVIA-PION PIiELING 471) I <br /> ❑ i.Cl IUMICAt.PRODUC f S f ORAGF. ❑ 4 I I A7.ARDOUS W'.AS I E(fnlludex t,ced Uil) ❑ 5.t MFRC f;NC ti-GENERA"COR FUF'L(HSC'§2>2S 1 S(c)I <br /> ❑ 6.01WIR1iFNERARIRFLLL ❑ 95 UNKNOWN ❑ 99 OTHER(Specify), 319,1 <br /> CON1FIN TS Pr'IRol FIIM: ❑ IaKL:GULARUNILADED ❑ le MIDGRADLUNI_F.ADFD ® lb.PREMIUM M UNLEADEf) 44" <br /> ❑ DIESEL. ❑ i JET FUEL. ❑ 6 AVIATION GAS <br /> ❑ X IFTROLEUM BLEND FUEL ❑ 9 OTHERPEIROLEUM(Spenfy) 440a <br /> NON-PETROLEUM.[11'SED CIL _ ❑ <br /> 10 L CHANOI. <br /> ❑ I 1 OILIER NON-PETROL PL'M(Slxci f1,) 4401 <br /> IV. TANK CONSTRUCTION —� <br /> f YPF OF LANK ❑ I SINGLE WALL ® 2 1x)1 BIL a AL L. ❑ 9 t Nt NOW N 413 <br /> PRIMARY CONTAINMENF -z STEEL INT[;12NAIIN( <br /> I - ❑1. FIBI <br /> L <br /> STEEL RGASS 0 ) UNKNOWN I FEAl .BLADDFR _ ...__. _..._ 143 _ <br /> ❑ 99 OTHER(Spec if,) 4.143 <br /> SECONDARY CONTAINMENT ❑ 1 STEEL ❑3_FIBERGLASS ❑ 6 EXTERIOR MEMBRANE LINER M - JACKETED 443 <br /> ❑ 90 NONE ❑ 95 UNKNOWN E]99 OTHER(Specify) 445,1 <br /> OVERFILL PREVENTION ❑ I AUDIBLE&VISI 11.ALARMS ❑ 2.BALL FLOA C ® FILL J UBI SHUT-OFF VALVE Y5= <br /> ❑ 4.TANK MEETS Rk C UIRENUENTS FOR FXEMI'CION FROM OVERFILL PREVENTION FQI.JIPMENT <br /> V. PRODUCT/WASTE PIPING CONSTRUCTION <br /> PIPING CONSTRt ❑ I.SINGLE WALL_ ® 2 DOUBLE WALL C199 OTHER 4 <br /> SYSTEM FYPL ® 1 PRESSURE. C] (JRAVITY El ' CONVENFIONALsivrION ❑ 4 SAFESUCTION[23CCR§26.4o1a)1;)T_.- "`S <br /> PRIMARY CON FAINNUEN I ❑ I STEEL ® 4 FIBERGLASS ❑ 8 FLEXIBLE; ❑ 10 RIGID PLASTIC '!04 <br /> ❑ 90 NONE ❑ 95 UNKNOWN ❑ 99 OFHER(Spec)fr): 4643 <br /> SECONDARY CONTAINMENT ❑ I STEEL ® 4 FIBERGLASS ASS ❑ S FLEXIBLE ❑ 10 RIGID PLAST[C <br /> ❑ 90 NOW, ❑ 95 UNKNOWN ❑ 99 OTHER(SpecitN) 464, <br /> Ill PING)TURBIN ECON IAINMENTSUNIPTYPE ® I SINGL.F WALL ❑ 2 DOUBLE WALL ❑ 90 NONE: 464 <br /> V <br /> VI. VENT,VAPOR RECOVERY (VR)AND RISER/FILL PIPE PIPING CONSTRUCTION <br /> VENT PRIMARY CONTAINMENT ❑ I STEEL d.FIBERGLASS ❑ 10 RIGID PLA`;1IC 9 46Ae <br /> ® ❑ 90 NONE ❑ )Y OCHER l;Spr tit,)- 4 <br /> VENT SECONDARY CONTAINMENT C1I STEEL ❑ 4_FIBERGLASS C110 RIGID PLASTIC ® 90.NONE. ❑ IN OTHER(Specify): 464E <br /> VR PRIMARY CONTAINMENT ❑ 1 STEEL ® 4.FIBERGLASS C1IQ RIGID PLASTIC ❑ 90 NONE ❑ 99 OCHERISpeclfy): 464&46�, <br /> _ - <br /> VR SECONDARY CONTAINMEN F ❑ 1 STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90_NONE ❑ 99.OTHER(Specify): 16441, <br /> VENT PIPING TRANSITION SUMP TYPE ❑ 1 SINGLE WALL ❑ 2.DOUBLE WALL ® 90NONE 464. <br /> RISER PRIMARY CONTAINMENT 01 STEEL. ❑ 4_FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 464j <br /> RISER SECONDARY CONTAINMENT ❑ 1 S"IEEL ❑ 4.FIBERGLASS ❑ 10 RIGID PLASTIC ® 90 NONE ❑ 99 OTHER(Spec,(,): 464k I <br /> . __... ...___.. _ ..._.._. 464k1 <br /> FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET ® 3.STRIKER PL.ATEABO'I-rOM PROTECFOR ❑ 4 CONT'AINMENC SUMP 451a•c <br /> VII. UNDER DISPENSER CONTAINMENT (UDC) <br /> CONS E RUCTION TYPE ® 1.SINGLE WALL ❑ '_ DOUBLE WALL ❑ 3_NO DISPENSERS <br /> [1 90_NONE 41,93 <br /> CONSTRUCTION MATERIAL ® 1 STEEL_ ❑ 4 FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 99 OTHER(Specifv) 4691, <br /> VIII. CORROSION PROTECTION <br /> STEEL COMPONENT PROTECTION ❑ 2,SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ® 6_ISOLATION 448 <br /> IX. APPLICANT SIGNATURE <br /> C'ER'1IFI(A"['IC)V: I certify that this I'ST system is compatible with the haaardous substance stored and that the information provided hereit,,js true. <br /> accurate,and in full compliance with legal requirements, <br /> ` s <br /> APP1.(CANT sIG ATuRE DATE 3/4/2010 310 <br /> 431 � 4, <br /> APPLICANT NAME(print) Sandy Ed VardS [ APPLICANT TITLE Environmental Compliance <br /> t'PCF UST-11 Rev.(12/2007)-1/2 www.unidocs.org _u <br /> r <br />