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IFIED PROGRAM CONSOLIDATED F UNDERGROUND STORAGE TANK 879-DlUl PRAD09-186 OPERATING PERMIT APPLICATION-TANK INFORMATION (One form per UST) TYPE OF ACTION (Check one item only. For a UST closure or removal,complete only this section and Sections 1,11,111,IV,and IX below) 430. ❑ 1.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: 430x. I DATE EXISTING UST DISCOVERED: 430b. I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) _ V D _ 1 BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3. Lawrence Livermore National Laboratory - 300 BUSINESS SITE ADDRESS 103. 1 CITY 104, Corral Hollow Road South of Tracy, CA IL TANK DESCRIPTION TANK ID#879-D1 U1 432. TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434. 390002319450194501 Modern Welding Co., Inc. ® 1.A STAND-ALONE TANK Complete one page for each g ❑ 2.ONE IN A COMPARTMENTED UNIT compartment in the unit. DATE UST SYSTEM INSTALLED 435, TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437, 1987/11 5,000 1 III. TANK USE AND CONTENTS TANK USE ® ]a.MOTOR VEHICLE FUELING ❑ lb.MARINA FUELING ❑ 1 c.AVIATION FUELING 439. ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§252815(c)] ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 439a. ..................................................................................................................................................................................................................................................................................................................................................................................................................................................................:..... ....... .... CONTENTS PETROLEUM: ❑ ]a.REGULAR UNLEADED ❑ ]c.MIDGRADE UNLEADED ❑ ]b.PREMIUM UNLEADED 440. ® 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM(Specify): 440a. ............................................................................................................................... ................................................................................................................. ..................................................................................................................... ............................................. NON-PETROLEUM:CI 7.USED OIL ❑ 10.ETHANOL ❑ 1 L OTHER NON-PETROLEUM(Specify): 440b. IV. TANK CONSTRUCTION TYPE OF TANK ❑ L SINGLE WALL ® 2.DOUBLE WALL ❑ 95.UNKNOWN 443. ...................................................................................................................................................................................................................................................... PRIMARY CONTAINMENT ® L STEEL ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444. ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN El99.OTHER(Specify): 444a. ..............................................................................................................................................................................................................................................................................................................................._..................................................................................................................... SECONDARY CONTAINMENT ❑ 1.STEEL ❑3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445. ❑ 90.NONE ❑ 95.UNKNOWN ®99.OTHER(Specify): STEEL CLAD w/FRP 445a. ............................................................................................................................................................................................................................................................................................................................................................ .................................................. OVERFILL PREVENTION ❑ 1.AUDIBLE&VISUAL ALARMS ❑ 2.BALL FLOAT IN 3.FILL TUBE SHUT-OFF VALVE 452. ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ® 1.SINGLE WALL ❑ 2.DOUBLE WALL [399.OTHER ................._460. ............................................................................................................................................................................................................................................................................................................. ........................................................................................................................................................................................................................................ ..... SYSTEM TYPE ❑ 1.PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ® 4.SAFE SUCTION[23 CCR§2636(a)(3)] 458. ...................................................................................................................................................................................................................................................... PRIMARY CONTAINMENT ® L STEEL ❑ 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464x. ..................................................................................................................................................................................................................................................................................................................................._............................................ ..................................................... SECONDARY CONTAINMENT ❑ L STEEL ❑ 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464b. ® 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c. ............................ . .. . . . ... ......................................................................................_................................................................................................................................................................. ................................. PIPING/TURBINE CONTAINMENT SUMP TYPE ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464d. VI. VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ® L STEEL ❑ 4.FIBERGLASS El10.RIGID PLASTIC ❑ 90.NONE [199.OTHER(S ecif 464e. P Y) 464e1. ................... 4 VENT SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS [I ]0.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 4 fl ............................................................................................._.........................................................................................................................................................................---................................................................................................................................................................................................................................. ...4 ...:..... VR PRIMARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): q�4Sg. ........................................................................................................................................................................................................................................................................_..................................................................................................................................................................................................................................... VR SECONDARY CONTAINMENT [11.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 464h]. .....................................................................................................................................................................................-.................................................................................................................................................................................................................................................................................................................... VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE 4641. ......................................................................._........................................................................................................................................................................................................................ RISER PRIMARY CONTAINMENT ® L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): g464j. ............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................... 464k. RISER SECONDARY CONTAINMENT ® 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99 OTHER(Specify): 464kt ...................................................................................................................................................................................................................................................._._.................................................................................................................................................................................................................................................... ............. FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET ® 3.STRIKER PLATEBOTTOMPROTECTOR ❑ 4.CONTAINMENT SUMP 45lac. VII. UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ® 1.SINGLE WALL [12.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 469a. ........................................................................................................................................................................................-.............................._.........._............................................................................................................................................................_........................................................................... CONSTRUCTION MATERIAL ® L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) gbgb. MM VIII. CORROSION PROTECTION IA; STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODES ❑ 4.IMPRESSED CURRENT ® 6.ISOLATION "'m 448. IX. APPLICANT SIGNATURE c.2 CERTIFICATION: I certify that this UST system is compatible with the hazardous substance stored and that the information pro ided herein is true, accurate,qpd in full com fiance with legal requirements. APPLIC � DATE azo. APPLICANT NAME(print Sav Mancieri 471 APPLICANT TITLE Division Leader,Permits and Regulatory Affairs Division 472 UPCF UST-B Rev.(12/2007)-1/2 www.unidocs.org