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UNIFIED PROGRAM CONSOLIDATED FORM. <br />UNDERGROUND STORAGE TANK <br />ON -.. NK INFORMATION (Pile form pt r UST) <br />OPERATING PERMIT APPLICATITA <br />TYPE OF ACTION (Check one iten) only. For a UST closure or remol al, conq)lete only this section and Sections 1, 11Ill, IK and LY below) <br />1. NEW PERMIT :. El 3. RENEWAL PERMIT ® 5. CHANGE OF INFORMATION <br />❑ b. TEMPORARY UST CLOSURE ❑ 7. UST PERMANENT CLOSURE ON SITE ❑ 8. UST REMOVAL <br />DATE UST PERMANENTLY CLOSED: a3oaDATE EXISTING UST DISCOVERED;. '' 4306. <br />!I,`TYNOATIQ�Igg <br />:_.._..... <br />f <br />FACILITY ID #, (Ageirc), Use Only) El <br />BUSINESS NAME (Sane as Faciitty Nome or DRA-Doing Business As) 3' <br />FLYERS #427 <br />l04 <br />BUSINESS SITE ADDRESS.. 103. CITY . <br />3300 'Waterloo Rd..: Stockton...... <br />f ITV /F <br />�A!NE31�0 <br />✓- N- <br />TANK ID tl 432, <br />TANK MANUFACTURER 433-. TANK CONFIGURATION THIS TANK IS 434. <br />42702 <br />TlUSCO ® 1: ASTAND-ALONETANK :' Compteteonepageforeach <br />0 2.0NE IN A COMPARTMENTED UNIT cwP-a-ent in the unit <br />DATE UST SYSTEM INSTALLED 435" ` <br />TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS IN THE UNIT 437. <br />Unknown <br />10,000 ' ... I <br />TANlCUSE ®Ia.MOTORVEl1ICLEFUELING ❑ Ib.MARiNAFUEL73dG ❑ 1c. AVIATION FUELING 439-. <br />0 3. CHEMICALPRODiJCT.SiORAGE '_ : , .0 :4. HA7ARI30US WA$TE{lnciudes Used Oilj (] :5. EMERGENCY GENERATOR FUEL [HSC §25281,5(c)1 <br />❑ 6.OTIIER GENERATOR 1 UfiL 0 4S. UNKNOWN ... ❑ 99.OTHER (Specify): 439a <br />CONTENTS .::PETROLEUM: ®Ia RCGUI ARUNLEADEb : ,. ,Q 1c.iyfiDGRADEUNLEADED . : [I :ttr.PREMIUMUNLEADED, 440. <br />❑ 3. D1E$EL :'.: D S. JETPUEL : ''. 0 6. AVIATION GAS <br />[]:S. PETROLEUM .BLEND FUEL p 9.OTHERPETROLEUM(Specify): 940a <br />WON -PETROLEUM: p '7. USED QIL 0 IO ETHANOL <br />0 :11, OTI RNON PETROLEUM(S mf )•.::: <br />TYPE OF TANK. Cl I. SINGLE WALL 02. DOUBLE WALL 0 95_ UNKNOWN 443. <br />PRIMARY CONTAINMENT:O !.STEEL :` :' 0 3. FIBERGLASS `. Q 6. INTERNAL BLADDER444. <br />. <br />D 7.STEEL #TNTERNALLINFNG0 95.UNKNOWN ❑ 44.OTHER (SpecEfy:.. 444x <br />SECONDARY CONTAINMENT :.® t. STEEL 0 3. FIBERGLASS 0.4. EXTERIOR MEMBRANEIINER ®.7. JACKETED 445. <br />0 90.NONE 95.TJi31CNOlW OW. OTHER Specify): 44$a <br />OVERFILL PREVENTION 0 :I. AUDIBLE B: VISUAL ALARMS ©.2. BALL FLOAT ®.3. FILL TUBE SHUT-OFF VALVE 452: <br />❑ 4.TANKMEETSRE. UIREMENTSFOREXEmpTIOyJTIFROrMtYOVERFIILPREYENTIONEQUIPMENT <br />PIPENG CONSTRUCTtON.I .. ❑ I. SINGLE WALL `® 2. DOUBLE WALMON <br />L ` ❑ 99.'OTHER..: 460. <br />SYSTEM TYPE ®i. PRESSiiRE ' Q `2. GRAVITY.. ❑ i 3. CONVENTIONAL SUCTION:: 0 4. SAFE. SUCTION (23 CCR 263 a 3))..458. <br />PRIMARY CQNTAINMENT : O L STEEL :,': 4,FIBERGLASS : ❑ 8.FLEXIBLE.' © 10 RIGIAPLAS. act•,' <br />. <br />0 90 NONE :I 95. UNKNOWN ` 0 99.OTHER (S city). ': 464a <br />SECONDARY CONTAINMENT []:I,STLEL '.'. ®4. FIBERGLASS 0 S.FLEXIBLE [ ]0 RIGID PLASTIC 46ab.. <br />0 '90.NONE.': 0 95. UNKNOWN 0 99.OTHER (Spemfy) 464c <br />PIPING/TURBINE CONTAINMENT SUMP TYPE 0 I. SINGLE IVALL : G. 2. DOUBLE WALL O 90 NOI iE 4c4a <br />f <br />,'.VENT:PItIMARYCONTAINMENT p.�,:$TEEL':`®.:4.FISERGLASS_.'. ❑:IO.RIGIDPI.ASTIC CI'90.NONE ❑.99.OTHER(Spectfy) :', 4Glat: <br />VENT SECONDARY CONTAINMEI�fT ❑ 1. ST1�L .':O, 4.I ISERGLASS '; Cl 10. RiGIR Pi ASTIC :®..90, NONE ❑ 99.OTIlER(Spec�fy} 464f l; <br />YR PRIMARY CONTAINMENT...... [� I::STEEL ;:� 4. FIBERGLASS; O IO.R[GIDPIiA$TIC :0,90.NONE. ❑ 99.OTIIER($pecify). q4W& <br />VRSIICONDARYCONTAINMCNT.:.` 0. !: STEEL ..❑ 4.FE3ERGLASS .:: ❑ l{).1tIGIDPLASTIC ®.90.NONE D 99.OTHER(Specify) 446ah1: <br />YENTPl.PINGTRANSITEONSUMP TYPE- 0:1.SINGLEWALL '❑ 2.DOU9LEWALL ® 90.NONE ate'" <br />.464 <br />1.TEEL .4. Q I0.RIGIDPLASTIC 0.90. NONE 99.O464RISERPRIMAtYCONTAINMENT.:® ❑ <br />RISER SI CONDARY CONTAINMENT O:I. STEEL ::❑ 4. FIBEtiGLASS.,': CI. 10. RIGID PLASTIC : 0.90. NONE 0 :99.OTHER (Specify)• <br />FILL COMPONENTS INSTALLED ..:.. . PROTECTOR ❑ 4 NT SUMP4SIa c . <br />is S.PILI BUCRllifift,jjK]�ET ®�t3. TRisba <br />/{® <br />1�kYF� I1iPP:NI`l,R,TM�.�-:P. -. <br />-S <br />CONSTRUCTION TYPE 1. SINGLE WALL .. ❑ 2: DOUBiI WALL -❑ 3.%40 DISPENSERS ❑ 90 NONE a6>a <br />CONSTEZ[1CTION:MATERIAL ., ... ®!:.STEEL : `.:: p 44,^{FISERGLAss . [] :,10 RIGID,PLASTIC :.: Q :99, OTHER (Specify) 469c .: <br />STEEL COMPONENT PROTECTION. 0'.2 SACRIFIC1ALAhiODE(S) .. ❑ # IMP1tCSSIID CURRENT D 6 1SOLATIQN <br />y}N <br />CERTIEICATIO\T: I certify that tEus UST system Is, conip>ttiUle �sltli :the hazardous si�listallce stored anrt:tlrat the lrifarsnaicon 1lrollrteii ile3eln�ls true,. <br />accniate, a in fettl cool Itatrce Svltlr 1 al 1•c wrcments `' <br />APPLICANT SIGNATURE .: <br />DATE a o. <br />Sj� 8/2012 <br />471 <br />APPLICANTNAME (pool) AlTlailt a i� ppelt <br />APPLICANT TITLE ' g 42z. <br />Enviromnental Marra er <br />UPCF UST -B Rev. (IM907) I/l www.mrldocs.org <br />