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•r IED PROGRAM CONSOLIDATED FOR* IJNDERGROGUND STORAGE TANK ? ' OPERA'T'ING PERMIT APPLICATION- TANK INFORMATION (One form 2er usT) 'I'YI'E OF ACTION ❑ L NEW SI'Z'E PERMIT T] 3.RENEWAL PERMIT ❑ , 5.CHANGE OF INFORMATION 430 (Check only ileal only) ❑ 6ATMPORARY SITE CLOSURE ❑ 7.PERMANENTLY CLOSED ON SITE ❑ 8.TANK REMOVED o DATE UST PERMANENTLY CLOSED: 430. DATE EXISTING UST DISCOVERED: 430b I:'TACILITY INTORl4ATION . FACILITY ID#(Agency Use On1J) FA0000279 1 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 ESCALON MINI MART BUSINESS SITE ADDRESS 103 CITY 104 1097 YOSEMITE AVE ESCALON ILTANKD.ESCRIPTION TANK ID# 432 TANK MANUFACTURER 433 TANK CONFIGURATION:THIS TANK I5 434 ❑ 1.A STAND-ALONE TANK TA05078Bd' q JOOR [g 2.ONE IN A COMPARTMENTED UNIT DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 05/15/1998 13000 ' 2 TH TANK iJSE'ANDtC(jNTENTS TANK USE la.MOTOR VEHICLE FUEL ❑ Ib.MARINA FUELING ❑ Ic.AVIATION FUELING ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE ❑ 5.EMERGENCY GENERATOR FUEL ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(Snecifv): CONTENTS PETROLEUM: ® la.REGULAR UNLEADED ❑ lc.MIDGRADE UNLEADED I 1b.PREMIUM UNLEADED 440 ❑ 3.DIESEL ❑ 5.JET FUEL LJ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM (Specify): NON-PETROLEUM: ❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Suecifv): 440b IV.TANICGONSTRUCTION A TYPE OF TANK ❑ 1.SINGLE WALL 0 2.DOUBLE WALL ❑95.UNKNOWN 443 PRIMARY CONTAINMENT ❑1.STEEL ❑x 3.FIBERGLASS 1:16.INTERNAL BLADDER 444 ❑7.STEEL+INTERNAL LINING ❑95.UNKNOWN ❑ 99.OTHER 444a SECONDARY CONTAINMENT ❑ I.STEEL ❑x 3.FIBERGLASS ❑6.EXTERIOR MEMBRANE LINER ❑7.JACKETED 445 [198.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specify) OVERFILL PREVENTION Ell.AUDIBLE&VISUAL ALARMS ❑ 2 BALL FLOAT 0 3 FILL TUBE SHUT OFF VALVE 452 ❑4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT �a ; rzw 'r" _ x Ia) V�PRODI�GT/WASTE PIPING GONSTRUGTOIt � ; �rlts � fRe,F ;. t t "s 1, �. A.ra. w '� t .c. e PIPING CONSTRUCTION LJ 1.SINGLE-WALLED IM 2.DOUBLE-WALLED ❑ 99.OTHER" 460 SYSTEM TYPE 10L PRESSURE ❑2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION 458 PRIMARY CONTAINMENT ❑ L STEEL ❑4.FIBERGLASS 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464 ❑ 90.NONE [:195.UNKNOWN ❑ 99.OTHER 464a 464b SECONDARY CONTAINMENT ❑ 1,STEEL E]4.FIBERGLASS W8.FLEXIBLE El10.RIGID PLASTIC E]90.NONE E]95.UNKNOWN El 99.OTHER 464c PLPING/TURBINE CONTAINMENT SUMP TYPE I.SINGLE-WALLED ❑ 2.DOUBLE-WALLED ❑ 99.NONE 464d .Vr1POR REC,OVERY,(VR),AND;;RISEIU�III�L PIPE PIPING CONSTLICTION3 .y , "� '�" „r�' F .. . - . .., a WAR'VL VENT VENT PIRMARY CONTAINMENT 1.STEEL pg 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER 464e VENT SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC , 0.NONE ❑ 99.OTHER 464f VR PIRMARY CONTAINMENT ❑ L STEEL b 4.FIBERGLASS ❑ 12.RIGID PLASTIC ❑I 90.NONE ❑ 99.OTHER 464g VR SECONDARY CONTAINMENT ❑ L STEEL ❑ 4.FIBERGLASS ❑ 12.RIGID PLASTIC 90.NONE ❑ 99.OTHER 464h VENT PIPING TRANS...SUMP TYPE ❑ I.SINGLE-WALLED ❑ 12.DOUBLE-WALLED a99.NONE 464i RISER PIRMARY CONTAINMENT ❑X 1.STEEL ❑ 4.FIBERGLASS ❑ 12.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER 4641 RISER SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 12.RIGID PLASTIC 90.NONE ❑ 99.OTHER 464k FILL COMPONENTS INSTALLED 191 1.SPILL BUCKET ❑ 3.STRIKER PLATEBOTTOM PROTECTOR ❑ 4.CONTAINMENT SUMP 45la-c VII:;UNDER::D[SPENSER:CONTAINMENT(UDCji CONSTRUCTION TYPE ❑% 1.SINGLE-WALLED ❑ 2.DOUBLE-WALLED ❑ 3.NO DISPENSERS ❑*f . 'd*E 469a CONTRUCTION MATERIAL ❑ l.STEEL 4.FIBERGLASS ❑ 10.RIGID PLASTIC 90.NONE ❑ 99.OTHER �+.4::_. 469b-c VIII CORROSION PItOTEGTION �i + �i Raq.v., )zik+s.t Mn?g e, ...<'�, 1e 4.,, '.,..� .:aj.l�' .Q .r..- STEEL COMPONENT PROTECTION ❑ 2.SACRAFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT Y 6.ISOL 4 �a .. s `" izx? tit "; Ih.APPI KATION 5IGNA�URE ��`,1 r� , t I certify that this UST system is compatible with the hazardous substance stored and that the information provided herei true,accurate,and in full compliance with legal requirements. APPLICANT SIGNATURE DATE 03/ f / 3 470 APPLICANTNAME(print) BALWINDER SI GH 471 APPLICANT TITLE OWNER 472