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f4 Ah Aft <br /> UIWIED PROGRAM CONSOLIDATED FORIW <br /> UNDERGROUND STORAGE TANK <br /> OPERATING PERMIT APPLICATION-TANK INFORMATION (One form per UST) <br /> TYPE OF ACTION (Check one item only. For a UST closure or removal,complete only this section and Sections 1,11,111,IV,and IX below) n �3 <br /> ® g <br /> ❑ 1 NEW PERMIT ❑ 3 RENEWAL PERMIT 5 CHANGE OF INFORMATION {lCJ/�/` _1 <br /> El 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE C18.UST REMOVAL <br /> DATE UST PERMANENTLY CLOSED: 430. DATE EXISTING UST DISCOVERED: a3ob <br /> L FACILITY INFORMATION <br /> FACILITY ID#(Agency Use Only) - - 1 <br /> BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3 <br /> CRLLC #2705447 <br /> BUSINESS SITE ADDRESS 103 CITY 104 <br /> 1469 E. Hammer Lane Stockton, CA 95210 <br /> II. TANK DESCRIPTION <br /> TANK ID# 432 TANK MANUFACTURER 433 T K CONFIGURATION:THIS TANK IS 434 <br /> 1A STAND-ALONE TANK Complete one page for each <br /> 7 Xc? 112.ONE IN A COMPARTMENIED UNIT compartment in the unit. <br /> DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 <br /> 3/31/1998 12,068 <br /> III. TANK USE AND CONTENTS <br /> TANK USE ® la MOTOR VEHICLE FUELING ElIb MARINA FUELING ❑ lc AVIATION FUELING 439 <br /> ❑ 3 CHEMICAL PRODUCI STORAGE ❑ 4 HAZARDOUS WASIE(Includes Used Oil) ❑ 5 EMERGENCY GENERATOR FUEL[HSC§25281 5(c)] <br /> ❑ 6,OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99 OTHER(Specify): a39a <br /> _..._......_,.._­.__.._.._.-.__.-._- ---, ----- -- - --_......._.._. _.._.._.. .. _._._ _0 <br /> CONTENTS PETROLEUM: ® la REGULAR UNLEADED ❑ lc MIDGRADE UNLEADED ❑ 16 PREMIUM UNLEADED 440 <br /> ❑ 3 DIESEL ❑ 5 JET FUEL ❑ 6 AVIATION GAS <br /> ....... 8-PETROLEUM BLEND_FUEL_ ❑ 9.OTHER PETROLEUM(Specify): 440a <br /> NON-PETROLEUM: 7.USED OIL ❑ 10 ETHANOL <br /> ❑ 11.OTHER NON-PETROLEUM(Specify): a4ob <br /> IV. TANK CONSTRUCTION <br /> TYPE OF TANK ❑ 1 SINGLE WALL ® 2,DOUBLE_WALL ❑ 95 UNKNOWN 443 <br /> PRIMARY CONTAINMENT ❑ 1 STEEL ® 3 FIBERGLASS ❑ 6 INTERNAL BLADDER <br /> a4$ <br /> ❑ 7 STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99 OTHER(Specify): 444a <br /> .. .. 44$a <br /> SECONDARY CONTAINMENT ❑ I STEEL ®3 F'IBERGLAS'S ❑ 6 EXTERIOR MEMBRANE LINER ❑ 7 JACKETED 445 <br /> ❑ 90 NONE 0 95 UNKNOWN 99 OTHER(Specif): <br /> - - -- <br /> OVERFILL PREVENTION ❑ 1 AUDIBLE&VISUAL ALARMS ❑ 2 BALL FLOAT FILL TUBE SHUT-OFF VALVE d5 <br /> ❑ 4.TANK MEETS RE 0EMENTS FOR EXEMPTION FROM OVER L REVENTION EQUIPMENT <br /> V. PROI}UCT t WASTE PIPING'CONSTRUCTION <br /> PIPING CONSTRUCTION ❑ 1 SINGLE WALL ® 2 DOUBLE WALL 99 OTHER 460 <br /> SYSTEM TYPE _ �- PRESSURE ❑ 2 GRAVITY ❑ 3 CONVENTIONAL SUCTION ❑ 4.S AFE SUCTION(23 CCR§2636(x)(3)] 459 <br /> PRIMARY CONTAINMENT ❑ 1 STEEL ® 4 FIBERGLASS ❑ 8 FLEXIBLE ❑ 10 RIGID PLASTIC �i4 <br /> _ C] 90.NONE C195.UNKNOWN ❑ 99 OTHER(Specify_): 464a <br /> SECONDARY CONTAINMENT ❑ 1 STEEL ® 4 FIBERGLASS ❑ 8 FLEXIBLE ❑ 10 RIGID PLASTIC <br /> 4646 <br /> EI 90.NONE El 95.UNKNOWN ❑ 99 OTHER(Specify): a6ac <br /> PIPING/TURBINE CONTAINMENT SUMP TYPE �]�`1 SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464d <br /> VI. VENT,VAPOR RECOVERY (VR)AND,RISER/FILL?IPE PIPING CONSTRUCTION <br /> VENT PRIMARY CONTAINMENT ❑ 1 STEEL ® 4 FIBERGLASS ❑ 10 RIGID PLASTIC [390.NONE ❑ 99 OTHER(Specify): 464eel <br /> ..__.......- -...._ ..__._ ......_._..._._ ..... ....... ...._. ..... .. .- ___ ..... _. __ . 4464E <br /> VENT SECONDARY CONTAINMENT ❑ L STEEL ❑ 4.FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 90 NONE ❑ 99 OTHER(Specify): 464n. <br /> VR PRIMARY CONTAINMENT Cll STEEL ® 4 FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 90,NONE ❑ 99 OIHER(Specify): 4668g <br /> _..._ ..__ ._. .---. . ._... .. �. -.. ... ..__ ... .. _.._. 464h <br /> VR SECONDARY CONTAINMENT ❑ 1 STEEL ® 4 FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 90 NONE ❑ 99 OTHER(Specify): 464hl. <br /> .._..----............. ._.... .................... .._... .. ......... .. ...... .. .. - _ ... _ ...._. ...._ _.. .464i <br /> VENT PIPING TRANSITION SUMP TYPE ❑ I SINGLE WALL ❑ 2 DOUBLE WALL. ® 90 NONE <br /> 4641 <br /> RISER PRIMARY CONTAINMENT ® 1 STEEL ❑ 4 FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 90.NONE ❑ 99 OTHER(Specify): 4641, <br /> --- _.__ ......._ ....._ _ <br /> RISER SECONDARY CONTAINMENT ❑ 1 STEEL ❑ 4 FIBERGLASS ❑ 10 RIGID PLASTIC ® 90.NONE ❑ 99 OTHER(Specify): 46gkj <br /> _.___..._.......__.....___.__.___...._.._ _ ___. _..-__._ _.._ ....__....................... ....._....---�.____..__....__.._._.__., _ _ _._..... ........_......_„ <br /> FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET .STRIKER PLATEBOTTOM PROTECTOR ❑ 4.CONTAINMENT SUMP 451a-c <br /> VII. UNDERDISPENSER CONTAINMENT (UDC) <br /> CONSTRUCTION TYPE ® 1 SINGLE WALL 0 2 DOUBLE WALL ❑ 3 NO DISPENSERS ❑ 90.NONE 469a <br /> CONSTRUCTION MATERIAL ❑ L STEEL 0 4.FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 99 OTHER(Specify) 469c. <br /> VIII. CORROSION PROTECTION <br /> STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODES ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION 448 <br /> IX. APPLICANT SIGNATURE <br /> CERTIFICATION: I certify that thi system compatible with the hazardous substance stored and that the information provided herein is true, <br /> accurat fu om Iia a ith legalsearements. <br /> APPLICANT SIGNATUR DATE azo <br /> _� <br /> APPLICANT NAME(print) Chuck J. 1ch 471 APPLICANT TITLE Manager Of Compliance & Maint. 472 <br /> UPCF UST-B Rev.(12/2007)-1/2 www.unidocs.org <br />