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UNIFIED PROGRAM CONSOLIDATED FORM � 1 UNDERGROUND STORAGE TANK jp OPERATING PERMIT APPLICATION-TANK INFORMATION (One forGmlper U r)' '` ' TYPE OF ACTION (Check one item only. For a UST closure or removal,complete only this section and Sections 111 111,IV,and IX below) 430. ❑ 1.NEW PERMIT ❑ 3.RENEWAL PERMIT 0 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 430& 1 DATE EXISTING UST DISCOVERED: 430b. L FACILITY INFORMATION FACILITY ID#(Agency Use Only) 1. BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3 CRLLC/76#5446 BUSINESS SITE ADDRESS 103. CITY 104. 1403 Country Club Blvd. Stockton II. TANK DESCRIPTION TANK ID# 432. TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434. 3 Unknown ® 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. 1/1/1991 9,728 III. TANK USE AND CONTENTS TANK USE ® la.MOTOR VEHICLE FUELING ❑ lb.MARINA FUELING ❑ Ic.AVIATION FUELING 439. ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) [1 5.EMERGENCY GENERATOR FUEL IHSC§25281.5(c)] ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 439x. CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ® lb.PREMIUM UNLEADED 440. ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8 PETROLEUM BLEND_FUEL_ ❑ 9 OTHER PETROLEUM M(Specify): 440& ........ _.._. -.-_. NON-PETROLEUM.❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 440b. TANK CONSTRUCTION TYPE OF TANK1 SINGLE_W ® 2.DOUBLE WALL ❑ 95 WN 443. UNKNOWN _ -°-- PRIMARY CONTAINMENT [IL STEEL - ® 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444. Q 7 STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 444a --- - _ -- ---.._ .- .. _._..__.. __.._... .. _..._..---- ... _....... ...__. SECONDARY CONTAINMENT ❑ L STEEL ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445. - 0 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.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V.' PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ 1 SINGLE WALL ® 2 DOUBLE WALL 0 99 OTHER 460. ...---... .. _ - ....... -- --. ._... .... -.........._...._ _..--8. SYSTEM TYPE ® l PRESSURE ❑ 2_GRAVITY ❑ 3 CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR.... a)(3)] -- 458 PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464. ❑ 90.NONE [ 95.UNKNOWN 0-99.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 ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464d. VI. VENT,VAPOR RECOVERY(VR)AND RISER]FILL PIPEPIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ 1 STEEL ® 4.FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 4#441. -..-----_ . _--- _._._.....-. ---_._.... . .. _ .. ............ VENT SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS El 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER S a 464E ( � �) 464f1. VR PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 464g. ........ ........._. .._............._...-----_...__ .. ......_._._. . ._._..-----.-._..__.._. ... ._........ -... ..._.. '.. 464 1. VR SECONDARY CONTAINMENT ❑ 1 STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 464h 1. _..--.....---.._.. .. ----._ .. ..._..__.. .. ...... _._.__....-.__.. ... ........ VENT PIPING TRANSITION SUMP TYPE ❑ I.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE 4Mt -..-.. _.......... . . . .... .__..... _..._.. _-..-._....._. . .. ...... _. ...... RISER PRIMARY CONTAINMENT ® 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify):fY) aea4i. RISER SECONDARY CONTAINMENT ❑ 1.STEEL [14.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 464k1. FILL COMPONENTS INSTALLED --® 1.SPILL BUCKET ❑ 3.STRIKER PLATE/BOTTOM PROTECTOR - ❑ 4.CONTAINMENT SUMP 45la-c. VII. UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ® l SINGLE WALL ❑ 2.DOUBLE WALL ❑ 3 NO DISPENSERS 0 90 NONE 469& CONSTRUCTION MATERIAL ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 469b: VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION 4a8. 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 full compliance with legal requirements. APPLICANT SIGNATURE DATE �'�� 470. APPLICANT NAME(print) Allen FaaSS 471. APPLICANT TITLE California Compliance Manager 472 UPCF UST-B Rev.(12/2007)-1/2 www.unidocs.org