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UNIFIED PROGRAM CONSOLIDATED FORM _65 j - 1 UNDERGROUND STORAGE TANK '� r-,a C iti1,sj::S 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 I,II,III,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: 4308 DATE EXISTING UST DISCOVERED: 430b. L FACILITY INFORMATION FACILITY ID#(Agency Use Only) - - 11 1. d BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3. CRLLC #2705446 BUSINESS SITE ADDRESS 103. 1 CITY 104. 1403 Country Club Blvd. Stockton II. TANK DESCRIPTION TANK ID#-" (` _ 432. TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434. r ~ tJ Unknown ® 1.A STAND-ALONE TANK Complete one page for each ❑ 2.ONE IN A COMPARTMENTED UNIT compartment in the wit. DATE UST SYSTEM INSTALLED 435. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS IN THE UNIT 4377, 1/1/1991 9,728 III. TANK USE AND CONTENTS TANK USE ® la.MOTOR VEHICLE FUELING ❑ ]b.MARINA FUELING ❑ lc.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): 439x. - ......... ....... ........ - CONTENTS PETROLEUM. ❑ la.REGULAR UNLEADED ❑ lc.MIDGRADE UNLEADED ® 1b.PREMIUM UNLEADED 440. ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM(Specify): 440& NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 4406. IV. TANK CONSTRUCTION TYPEOF 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 [199.OTHER(Specify): 445a. 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 ® 2.DOUBLE WALL ❑ 99.OTHER 460. SYSTEM TYPE ® 1 PRESSURE ❑ 2.GRAVITY 0_3 CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION 123 CCR§2636(a)(3)] 458. PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS C] 8.FLEXIBLE E] 10.RIGID PLASTIC 464. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 4646. ❑ 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 ❑ 1.STEEL N 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): a64e1. _. .. ......_.._ ........ 4641. VENT SECONDARY CONTAINMENT ❑ L STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 4648 __.._..._.. ..__..___..._. ......._._..._ ..__..__.._.... .__..__......_ ....._ .. ._.............. .... ... ..__.._. ...._....._ _..__.___ .._____._.. ...._............... ...__.. aha VR PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC [190.NONE ❑ 99.OTHER(Specify): 4�,a i VR SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): g64hj. ._..__._.._.....__..._._.._.._........_......_............._...-_._...__....._......_....._.-.._......___-....._...................._...----___....._............-.-_...__..._.._-..._.._.._...__.._._...._....._......_....__.._........-_....._...__._._.._...._.....__...._.....__..__._....._....__....__...---- -- VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE 464i _......... . . -____ ____ _ RISER PRIMARY CONTAINMENT ® 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 4464j. ........._........._...__...__.__.__-__.._____ __.__..__ -.-.._...-_.....___-__....._.._-._-.._....._-.._... ..._...-_.--._-_- _- --_-__ .-_.-_. _.._.__.._...._...M..._.... 464. RISER SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 464k1. .__..._...._...._.___-_.....__..._....__.._... ___....._..._..._ -- FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET IQ 3.STRIKER PLATE/BOTTOM PROTECTOR ❑ 4.CONTAINMENT SUMP 45la-c VII. UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE ®_1_SINGLE WALL ❑ 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 4698. _.... ...._..._. ---...----.._..._..__._.... __ ...__._.... ...... _ ... _....... . --....._...._._ CONSTRUCTION MATERIAL ❑ 1.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 that this UST system is compatible with the hazardous substance stored and that the information provided herein is true, accurate and in I com lianc r uirements. APPLICANT SIGNATURE DATazo. E 05 APPLICANT NAME(print) Armen MkAyclllan 471' APPLICANT TITLE California Compliance Manager 472 UPCF UST-13 Rev.(12/2007)-1/2 www.unidocs.org