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3 <> UNIFIED PROGRAM CONSOLIDATED FORM a ,(�. : �•y 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 4 II,III,IV,and IX below) 430 ❑ l 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: 430b I. FACILITY INFORMATION FACILITY 1D#(Agency Use Only) C., 413 a BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3. CRLLC #2705446 BUSINESS SITE ADDRESS 103 CITY 104 1403 CopClub Blvd. S'?tockkt�o*n CA 95204 _ ¢..:i, Y TANK ID# 432 TANK MANUFACTURER 433 'ANK CONFIGURATION:THIS TANK IS 434 �y1.A STAND-ALONE TANK Complete one page for each F' qS� c C) 2.ONE INA COMPARTMENTED UNIT compartment in the unit. DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS ' 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 1/1/1991 9,728 J "N A : II�:� T ► SFi ANIONTrTc ,� µ U x'� a TANK USE ® la MOTOR VEHICLE FUELING ❑ 1b MARINA FUEL r ING ❑ lc AVIATION FUELING 439 ❑ 3 CHEMICAL PRODUCT STORAGE ❑ 4 HAZARDOUS WAS I E(Includes Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§252815(c)) _ _ [:] 6.OTHER G.ENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 439a. ......_ ._..----- .__..__. .._..._.__.._..____._.._. _.__..._ .. ___ CONTENTS PETROLEUM: 1 I a.REGULAR UNLEADED ❑ 1 c MIDGRADE UNLEADED "Ib, PREMIUM UNLEADED 440 ❑ 3 DIESEL ❑ 5 JET FUEL ❑ 6 AVIATION GAS ❑ 8 PEIROLEUM BLEND FUEL [19.OIHER PETROLEUM(Specify): 440a NON-PETROLEUM:❑ 7 USEDOIL�•"-____._.____.._ I] 10.ETHANOL -- -- - ❑ 11.OIHER NON PETROLEUM(Specify 440b 4:_,� ,� t ; •� x ky^' a ti�� .�a ,c ��j::moi � �1 6 i°• � 1 ;h y�x f P> _TYPE_OF TANK s _ [3 1.SINGLE WALL_ ® 2 DOUBLE WALL El 95.UNKNOWN - - 443 _ _ _ _ PRIMARY CONTAINMENT ❑ 1 STEEL ® 3 FIBERGLASS ❑ 6 INTERNAL BLADDER 444 __ _ _❑ 7.STEEL+INTERNAL L_D41NG_ [195.UNKNOWN _❑ 99.0 1 HER(Specify): 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 ❑ 2 BALL FLOAT 3 FILL TUBE SHUT-OFF VALVE 452 ❑ 4.IANK MEEIS RE REMENIS FOR EXEMPIION FROM OVERFI L PREVENTION EQUIPMENI PIPING CONSTRUCTION ❑ 1 SINGLE WALL ® 2 DOUBLE WALL ❑ 99 OTHER 460 -- -- - -- _ - __.-. .-. -. . SYSTEM TYPE _ -- l PRESSURE 0 2 GRAVITY [1 3 CONVENTIONAL SUCTION 0 4 SAFE SUCTION[23 CCR§2636(aX3)1 458 PRIMARY CONTAINMENT ❑ 1 STEEL ® 4 FIBERGLASS 8 FLEXIBLE ❑ 10 RIGIDPLASTIC 464 __ _ _ ❑ 90.NONE [195.UNKNOWN ❑_ 99.O_IHER(Specify): 464a SECONDARY CONTAINMENT LJ1 STEEL ® 4 FIBERGLASS ❑ 8 FLEXIBLE ❑ 10 RIGID PLASTIC 4646 ❑ 90.NONE 95.UNKNOWN ❑ 99.OIHER(Specify): 464c PIPING/TURBINE CONTAINMENT SUMP TYPE R 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 4644 ,. C. � 'SAP®R R�1W1��+� �S L�A�� 5 �( .��•L �� +�. �Ni 1�Ca��TR ��I1�� `Y b`f VENT PRIMARY CONTAINMENT r ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE [199.OIHER(Specify): 4644ee1. VENT SECONDARY CONTAINMENT E] 1.STEEL ❑ 4.FIBERGLASS [110.RIGID PLASIIC E] 90.NONE [199.0 464f. IHER(Specify): 464E VR PRIMARY CONTAINMENT ❑ 1 STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASIIC ❑ 90.NONE ❑ 99.OTHER(Specify): 464gt VR SECONDARY CONTAINMENT' ❑ 1 STEEL ® 4 FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 90 NONE ❑ 99 OTHER(Specify): 46ahl. _ _.... . _ _. _ VENT PIPING TRANSITION SUMP TYPE [I1 SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE 464r ._.---'--._____....,__._._.• _......._.. _.__..._ - - _. 4641 RISER PRIMARY CONIAINMENT ® L STEEL ❑ 4 FIBERGLASS ❑ 10.RIGID PLASIIC ❑ 90.NONE ❑ 99.OTHER(Specify): q l RISER SECONDARY CONTAINMENT' [I1,SIEEL El4.FIBERGLASS [110 RIGID PLASTIC_ ® 90.NONE El 99 OTHER(Specify): 464k1 FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET 3.STRIKER PLATEBOTTOM PROTECTOR ❑ 4.CONTAINMENT SUMP 451a-c MY tTNIR DISPENSER CON'I'AINIVIENT(iTDC) CONSTRUC_TION TYPE 0 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469a __.-.--••.--- _...- _ 4696 CONSTRUCTION MATERIAL ❑ I STEEL ® 4.FIBERGLASS ❑ 10.RIGIDPLASTIC ❑ 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 that1s US syste s ompa ' e ith the hazardous substance stored and that the information provided herein is true, acc e, d n om li as KaWquirements. APPLICANT SIGNAT DATEl 470 � d 471 APPLICANT NAME(print) Chuck . Softich 471 APPLICANT TITLE Manager of Compliance & Maint.