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UNIFIED PROGRAM CONSOLIDATED FORM c�- _ "•% UNDERGROUND STORAGE TANK 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/,11,111,IV,and IX below) 430 ❑ I NEW PERMIT ❑ 3 RENEWAL PERMIT ® 5 CHANGE OF INFORMATION ❑ 6. TEMPORARY USTCLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 430a DATE EXISTING UST DISCOVERED: a3ob I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) - - a� � BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3 CRLLC #2705446 BUSINESS SITE ADDRESS 103 CITY 104 1403 Country Club Blvd. Stockton, CA 95204 II. TANK DESCRIPTION TANK ID# 432 TANK MANUFACTURER 433 TANK CONFIGURATION:THIS TANK IS 434 1 A SI AND-ALONE I ANK Complete one page for each 2.ONE IN A COMPARIMENIED UNII compartment in the unit. DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OCOMPARTMENTS IN THE UNIT 437 1/1/1991 _ 9,728 _ III. TANK USE AND CONTENTS TANK USE ® la MOTOR VEHICLE FUELING ❑ lb MARINA FUELING ❑ 1c AVIATION FUELING 439 ❑ 3 CHEMICAL PRODUCT STORAGE ❑ 4 HAZARDOUS WAS I E(Includes Used Oil) ❑ 5 EMERGENCY GENERATOR FUEL(HSC 125281 5(c)] ❑ 6 OIHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 439a _....._.................... ...........__.._.._._.-....._ _..... 440 CONTENTS PETROLEUM: ® la REGULAAUNLEADED ❑ is MIDGRADEUNLEADED ❑ lb PREMIUM UNLEADED 4ao ❑ 3 DIESEL ❑ 5 TET FUEL ❑ 6 AVIATION GAS ❑ 8 PETROLEUMBLEND FUEL 0 9 OTHER PETROLEUM(Specify): 440a _ NON-PETROLEUM:❑ 7 USEDOIL ❑ !0 ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 440b IV. 'TANK CONSTRUCTION _ TYPE OF TANK ❑ 1 SINGLE WALL ® 2 DOUBLE WALL ❑ 95 UNKNOWN 443 _..__...-_...... -- -....__..._._.._. -- --- _.. ._.__..- 444 PRIMARY CONTAINMENT ❑ 1 STEEL ® 3 FIBERGLASS ❑ 6 INTERNAL BLADDER ❑ 7.SIEEL+INTERNAL LINING ❑ 95 UNKNOWN ❑ 99.OTHER(Specify): 444a --- ...................._._...__..._. .......... -._.....------. ...... _.._....._...__............._..........__..._..........._I...._...._ - SECONDARY CONTAINMENT ❑ I STEEL ®3 FIBERGLASS ❑ 6 EXTERIOR MEMBRANE LINER ❑ 7 JACKETED as ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OIHER(Specify): 445a OVERFILL PREVENTION ❑ l AUDIBLE&VISUAL ALARMS ❑ 2 BALL FLDAT X3 FILL TUBE SHUT-OFF VALVE 452 El 4.IANK MEETS REQUIREMENIS FOR EXEMPTION FROM OVERFILL PREVFNT ION EQUIPMENI _ V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ I SINGLE WALL ® 2.DOUBLE WALL ❑ 99 OTHER 460 - .. .. SYSTEM TYPEI PRESSURE 0 2 GRAVITY 0 3 CONVENTIONAL SUCTION [14 SAFE SUCTION 12_3 CCR p2636(a)(3)] 458 PRIMARY CONTAINMENT [iLEXIBLE 1 STEEL ® 4 FIBERGLASS ❑ 8 F ❑ 10 RIGID PLASTIC 464 ❑ 90.NONE 0 95 UNKNOWN ❑ 99 OTHER(Specify): 464a SECONDARY CONIN TAMENT ❑ 1 STEEL ® 4 FIBERGLASS ❑ 8 FLEXIBLE ❑ 10 RIGID PLASTIC 4646 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99 OTHER(Specify): 464o PIPING/TUIN RBE CONTAINMENT SUMP TYPE 1. W SINGLE ALL ❑ 2.DOWALL UBLE ❑ 90.NONE 464d VI. VENT,VAPOR RECOVERY (VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ 1 STEEL ® 4 FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 90 NONE ❑ 99 OTHER(Specify): 464 e]; VENT SECONDARY CONTAINMENT ❑ 1 SIEEL. ❑ 4.FIBERGLASS ❑ 10.RIGID PLASIIC ❑ 90.NONE [1 99 OTHER(Specify): 464n _ _._. VR PRIMARY CONTAINMENT ❑ I STEEL ® 4.FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 90 NONE ❑ 99 OIHER .(Specify): g6gLj _. . . VR SECONDARY CONTAINMENT [I1 STEEL. ® 4 FIBERGLASS [110 RIGID PLASTIC [190 NONE El99 OTHER(Specify): 4464ht I.__....._.............. ..-__ ........ ......... .... _. _ _... _... - __. VENT PIPING TRANSITION SUMP TYPE ❑ 1 SINGLE WALL ❑ 2 DOUBLE WALL ® 90 NONEaha ..... ..... RISER PRIMARY CONTAINMENT ® 1 STEEL ❑ 4 FIBERGLASS ❑ 10 RIGIDPLASIIC ❑ 90,NONE ❑ 99 OTHER(Specify): gbgaj _.............. - ._..... ._.._.. _ _ _ _... RISER SECONDARY CONTAINMENT [I1 SIEEL ❑ 4 FIBERGLASS [1 10 RIGIDPLASTIC ® 90.NONE El 99 OTHER(Specify): 46ak FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET 3.STRIKER PLATEBOTTOM PROTECTOR ❑ 4.CONTAINMENT SUMP 451 a-c VII. UNDER DIMPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE ® 1 SINGLE WALL ❑ 2 DOUBLE WALL 0 3 NO DISPENSERS 0 90 NONE 469a . ......__._ _ .._.... ._ _ _ ..... ......... .._. 4696 CONSTRUCTION MATERIAL ❑ I STEEL ® 4 FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 99 OTHER(Specify) 469c. VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION 448 IX. APPLICANT SIGNATURE CERTIFICATION: I certify thatIs US syste s ompa ' ith the hazardous substance stored and that the information provided herein is true, acc e, n n com li 'ith a uirements. azo APPLICANT SIGNAL E DATE �f APPLICANI NAME(print) Chuck Oftich 471 APPLICANT TITLE Manager of Compliance & Maint. 472 I lPCF I I.CT_R Rev-f12/2f)(171-1/2 www.onidocc.or•e