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�I PQ qlI UPCF UST -A Rev. (12/2007) - UNDERGROUND STORAGE TANK - "a OPERATING PERMIT APPLICATION - TANK INFORMATION (One form per UST) � TYPE OF ACTION (Check one item only. For an UST permanent 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: 430a DATE EXISTING UST DISCOVERED: a3ob I. FACILITY INFORMATION FACILITY ID # (Agency Use Only) L j t BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3 ARCO 02130 BUSINESS SITE ADDRESS 103 CITY 104 7906 N. EL DORADO ST. STOCKTON II. TANK DESCRIPTION "THIS TANK ID # 1 432 TANK MANUFACTURER 433 TANK CONFIGURATION: TANK IS 434 Xerxes . A STAND-ALONE TANK /] �� r� G L� ❑ 2. ONE IN A COMPARTMENTED UNIT. /'"j i� Complete one page for each compartment in the unit. DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 1993/09 10,000 1 M. TANK USE AND CONTENTS TANK USE �W la. MOTOR VEHICLE FUELING ❑ lb. MARINA FUELING Cl 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): a39a CONTENTS PETROLEUM: ❑ la. REGULAR UNLEADED ❑ lc. MIDGRADE UNLEADED i lb. PREMIUM UNLEADED 440 ❑ 3. DIESEL ❑ 5. JET FUEL ❑ 6. AVIATION GAS ❑ 8. PETROLEUM BLEND FUEL ❑ 9. OTHER PETROLEUM (Specify): 440a NON -PETROLEUM: ❑ 7. USED OIL ❑ 10. ETHANOL 44ob ❑ 11. OTHER NON-PETROLEUM(Specify): IV. TANr_ CONSTRUCTION TYPE OF TANK ❑ 1. SINGLE WALL '2. DOUBLE WALL ❑ 95. UNKNOWN 443 PRIMARY CONTAINMENT ❑ 1. STEEL eMl3. FIBERGLASS [16. INTERNAL BLADDER 444 ❑ 7. STEEL + INTERNAL LINING ❑ 95. UNKNOWN ❑ 99. OTHER (Specify): 444a SECONDARY CONTAINMENT ❑ 1. STEEL _-JkS. FIBERGLASS ❑ 6. EXTERIOR MEMBRANE LINER ❑ 7. JACKETED 445 ❑ 90. NONE ❑ 95. UNKNOn ❑ 99. OTHER (Specify): 445a OVERFILL PREVENTION 1. AUDIBLE & VISUAL ALARMS ItQ. BALL FLOAT ❑ 3. FILL TUBE SHUT-OFF VALVE 452. 4. TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT /WASTE PXPING 'CONSTRUCTION PIPING CONSTRUCTION ❑ 1. SINGLE -WALLED 2. DOUBLE -WALLED [199. OTHER 460 SYSTEM TYPE -1. PRESSURE 2. GRAVITY ❑ 3. CONVENTIONAL SUCTION ❑ 4. SAFE SUCTION [23 CCR §2636(a)(3)] 458 PRIMARY CONTAINMENT 1. STEEL . FIBERGLASS ❑ 8. FLEXIBLE ❑ 10. RIGID PLASTIC 464 ❑ 90. NONE ❑ 95. UNKNOWN ❑ 99. OTHER(Specify): 464a SECONDARY CONTAINMENT ❑ 1. STEEL -4*•4. FIBERGLASS ❑ 8. FLEXIBLE ❑ 10. RIGID PLASTIC 464b ❑ 90. NONE ❑ 95. UNKNOWN ❑ 99. OTHER (Specify): 464c PIPINGITURBINE CONTAINMENT SUMP TYPE "1. SINGLE WALL ❑ 2. DOUBLE WALL ❑ 90. NONE 464d VI. VENT, VAPOR RECO " ,,,, ") AND RISER / FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ 1. STEEL . FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 90. NONE ❑ 99. OTHER (Specify) 464e 464e1 VENT SECONDARY CONTAINMENT ❑ 1. STEEL ❑ 4. FIBERGLASS ❑ 10. RIGID PLASTIC 90. NONE ❑ 99. OTHER (Specify) 464f 464n VR PRIMARY CONTAINMENT 1. STEEL ® 4. FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 90. NONE ❑ 99. OTHER (Specify) 4646 464 l VR SECONDARY CONTAINMENT ❑ 1. STEEL ❑ 4. FIBERGLASS ❑ 10. RIGID PLASTIC 90. NONE ❑ 99. OTHER (Specify) 464h 464hl VENT PIPING TRANSITION SUMP TYPE ❑ 1. SINGLE WALL ❑ 2. DOUBLE WALL 90. NONE 464i. STEEL ❑ 4. FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 90. NONE ❑ 99. OTHER (Specify) 464] RISER PRIMARY CONTAINMENT464" __W1. t RISER SECONDARY CONTAINMENT 0 1. STEEL 4. FIBERGLASS ❑ 10. RIGID PLASTIC nj ?. NONE 0 99. OTHER (Specify) 464k 464kl FILL COMPONENTS INSTALLED 1. SPILL BUCKET . STRIKER PLATE/BOTTOM PROTECTOR '4. CONTAINMENT SUMP 45la-c VII. UNDER DISPENSER GON�W (UDP' " CONSTRUCTION TYPE 1. SINGLE WALL ❑ 2. DOUBLE WALL ❑ 3. NO DISPENSERS ❑ 90. NONE 469a CONSTRUCTION MATERIAL 1. STEEL ❑ 4. FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 99. OTHER (Specify) 469b -c VIII. CORROSIONFROUCTION STEEL COMPONENT PROTECTION ❑ 2. SACRIFICIAL ANODE(S) ❑ 4. IvIPRESSED CURRENT 6. ISOLATION 448. IX. APPLIC NTSIGNATM 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 w' a re uirements. APPLICANT SIGNATURE DATE 470. APPLICANT NAME (print) BRATZURASAGOITIA 471. APPLICA TTlTIV. Environmental Compliance Specialist 472. UPCF UST -A Rev. (12/2007)