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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION(one torn per UST) ITYPEOFAC'TION (Check one item only. For an UST permanent closure or removal,complete only this section and Sections[,11,III,IV,and IX below) 430 ❑ I.NEW PERMIT ❑ 3.RENEWAL PERMIT ® 5.CHANGE OF INFORMATION 6,TEMPORARY UST CLOSURE 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 430a DATE EXISTING UST DISCOVERED: 4306 1. FACILITY INFORMATION FACILtrY ID N(Agencv Use Only) I BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 Pacific Bel[Telephone Company dba AT&T California UE020 BUSINESS SITE ADDRESS03 CITY 104 124 West Elm Street Lodi U.TANK DESCRIPTION TANK ID N 432 TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK IS 434 795 MODERN WLD ®1.A STAND-ALONE TANK ❑2.ONE INA COMPARTMENTED UNIT. Com fete one page for each com nment to the unit DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 2001 8000 1 III.TANK USE AND CONTENTS TANK USE ❑ la.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ lc.AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL piSC§25281.5(c)j ® 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 43% CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ❑ Ib.PREMIUM UNLEADED 440 ® 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM (Specifv): 440a NON-PETROLEUM:0 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(S eci 4406 IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE.WALL ® 2.DOUBLE WALL ❑ 95.UNKNOWN 443 PRIMARY CONTAINMENT ® 1.STEEL ❑ 3.FIBERGLASS 0 6.INTERNAL BLADDER 444 ❑ 7.STEEL.+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER (S eci!): 444a SECONDARY CONTAINMENT ❑ 1.STEEL ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445 ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specify): 445a OVERFILL PREVENTION ® 1.AUDIBLE&VISUAL ALARMS 0 2.BALL FLOAT ❑ 3.FILL TUBE SHUT-OFF VALVE 452. ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑I.SINGLE-WALLED ®2.DOUBLE-WALLED ❑99,OTHER 460 SYSTEM TYPE ❑ 1.PRESSURE ❑ 2.GRAVITY N 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR§2636(aK3)j 458 PRIMARY CONTAINMENT 0 1.STEEL ❑ 4.FIBERGLASS ® 8.FLEXIBLE ❑ 10 RIGID PLASTIC464 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHERISpecily): 464a SECONDARY CONTAINMENT ❑ I.STEEL ❑ 4,FIBERGLASS 8.FLEXIBLE ❑ 10.RIGID PLASTIC 4646 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(S city): 464c PIPING/TURBINE CONTAINMENT SUMP TYPE ® I.SINGLE WALL 2.DOUBLE WALT. ❑ 90.NONE 464d VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT I.STEEL 0 4.FIBERGLASS 10,RIGID PLASTIC 90,NONE 99.OTHER(Specify) 464e 464el VENT SECONDARY CONTAINMENT I.STEEL 4.FIBERGLASS ❑ 10.RIGID PLASTIC IM 90.NONE El 99,OTHER(Specify) 464f 464n VR PRIMARY CONTAINMENT I.STEEL. 4.FIBERGLASS 10.RIGID PLASTIC 1@ 90,NONE 99,OTHER(Specify) 4648 464g I VR SECONDARY CONTAINMENT 0 1,STEEL 0 4,FIBERGLASS 10.RIGID PLASTIC 0 90.NONE 99.OTHER(Specify) 4b4h 464h1 VENT PIPING TRANSITION SUMP TYPE 0 1.SINGLE WALL ❑ 2.DOUBLE WALL 90.NONE 464i. RISER PRIMARY CONTAINMENT 0 L STEEL 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE 99.OTHER(Specify) 4641 464 I RISER SECONDARY CONTAINMENT 0 1,STEEL 0 4.FIBERGLASS 10.RIGID PLASTIC 0 90,NONE 99.OTHER(Specify) 464k 464k1 FILL COMPONENTS INSTALLED 0 i.SPILL BUCKET 0 3.STRIKER PLATE/BO-TTOM PROTECTOR 4.CONTAINMENT SUMP 151- VII.UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE. ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ® 3.NO DISPENSERS ❑ 90.NONE 469a CONSTRUCTION MATERIAL ❑ 1.STEEL ❑ 4.FIBERGLASS Q 10,RIGID PLASTIC ❑ 99.OTHER(Specify) 4696-c VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4 IMPRESSED CURRENT ❑ 6.ISOLATION 44$ I% APPLICANT SIGNATURE CERTIFICATION: I certify that this UST system is compatible with the hazardous substance stored and that the information provided herein is true,accurate, and in full compliance with legal requirements. APPLICANT SIGNATURE DATE 470 6/3/2008 APPLICANT NAME(print) 471' APPLICANT TITLE 472 Steven J Hall Manager, EH&S UPCF UST-B-1/1 Rev.(12/2007)