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Alk 01 IFIED PROGRAM CONSOLIDATED FdW UNDERGROUND STORAGE TANK 879-G3U1 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) - 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 II. TANK DESCRIPTION TANK ID#879-G3U1 432. TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434. 390002319450505184 TfUSCO ® 1.A STAND-ALONE TANK Complete one page for each ❑ 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. 1994/06 15,000 1 III. TANK USE AND CONTENTS TANK USE ® la.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ 1 c.AVIATION FUELING 439. ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§25281.5(c)] ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 439a. _....._._..._..........._.............._........................-_____._....�__.....................__._.. ..._.............................._...............................................................................................................................__.._.__._._._......_......._........_...__......._.._.... ...................... CONTENTS PETROLEUM: ® Ia.REGULAR UNLEADED ❑ lc.MIDGRADE UNLEADED ❑ lb.PREMIUM UNLEADED 440. ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM(Specify): 440a. ..................._..._............................................................................_.._................ .............._.........__._..__........................__._............................... -.__.............................................................._........................ ..............I.............................. NON-PETROLEUM:�I 7.USED OIL I�10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 440b. IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 95.UNKNOWN 443. ........................................................................................................................................._.......................__.._ _.. .................................................................................................................-............................................................................................................................................ PRIMARY CONTAINMENT ® 1.STEEL ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444. ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 444a. _..._...................--'--....._..._......................................................................................_....................................................................................._.---_..............._..........._........................................................................................................................................................ SECONDARY CONTAINMENT ❑ 1.STEEL ❑3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445. ❑ 90.NONE ❑ 95_UNKNOWN ®99.OTHER(Specify): STELCLw/FRP 445x. ..........................._........... ............................ . ...................... ......... _ .................... ....._...--- ..... OVERFILL PREVENTION ❑ 1.AUDIBLE&VISUAL ALARMS ❑ 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 ❑ 1.SINGLE WALL N 2.DOUBLE WALL ❑ 99.OTHER 460. . ......................................................................................................_............. ._...................._...._.......__......__._� �.. ---.._.................................................................................................................................................._......-.__............_....__-�_........... SYSTEM TYPE ® 1.PRESSURE 0 2.GRAVITY __._.__0 3:CONVENTIONAL SUCTION .❑...4:..SAFE SUCTION[23 CCR.§2636(ax3)] ass -................................._..---._..__....................................................... .. PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464a ............................._.._................................................._........._................ ..............__..._...............................................................................__............................................................................_.__.._.........................__•-_ SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464b. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c. .................................................................._........_.._........._._......................................................................................................................................._............................................_......_._._ ......_.._.. _...._........... PIPING/TURBINE CONTAINMENT SUMP TYPE N 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464d. VI. VENT,VAPOR RECOVERY(VR) AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ 1.STEEL N 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 46ael. ..............._.._........................................................................................................................................................................................................._..._._................_..._..................................__....._._....._............................................... ...................... ......................................................................................................................._._. 6 VENT SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 464fl. .. ..................._-._._................................................................._............_.........._................................_........................................................__....._........................................................... ... �....... .4 . VR PRIMARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC N 90.NONE ❑ 99.OTHER(Specify): 46488 ..........................................................._....----............._..._................................................................_...................................................................---.....................................................................__.._......................................................_....._.._................._..................................................... VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 464hl. ..............................................................................................................._..........__.._..._......._....._..........._........................................._..............---._................................................................................................................................_.__......._._._..................................._............................_....................... ...................... VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL N 90.NONE 4641. __. ......................................................................................................................._._._.... .._.....................................___......................_.....__............................................................_................................................................._....._.........._.__.........................................._.........._..........................................__........................................................ 4 ..... RISER PRIMARY CONTAINMENT IN L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 46411 ...................................................................................................................................................................................---....._............................................._.._.._.......--.......__...................................................................._..........................................................._......---........................................_.. RISER SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS El 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 46644kkl. ......._...............................................................................................................................................................................--. .. . ..................................................... ......... ...................... FILL COMPONENTS INSTALLED ® L SPILL BUCKET ® 3.STRIKER PLATE/BOTTOM PROTECTOR ❑ 4.CONTAINMENT SUMP 451a-c. VII. UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469a. ......................................................._........................................................................................................................................_._......_............_.-_...._......_._......__.._...._..._..-- ....._....................................................._. CONSTRUCTION MATERIAL N L STEEL [34.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 469b: VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODES ❑ 4.IMPRESSED CURRENT ® 6.ISOLATION IN `. 448. IYC APPLICANT SIGNATURE CERTIFICATION: I certify that this UST system is compatible with the hazardous substance stored and that the information provided is true, accurate,and hjull cqppliance with legal requirements. APPLICANT S] DATE `O `3 470. APPLICANT§AYAT(print) Sav Maneieri V 471. APPLICANT TITLE Division Leader,Permits and Regulatory Affair l n 472 UPCF UST-B Rev.(12/2007)-1/2 www.unidocs.org