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U eIED PROGRAM CONSOLIDATED FORMW <br /> UNDERGROUND STORAGE TANK <br /> OPERATING PERMIT APPLICATION -TANK INFORMATION (One form perrUST) <br /> TYPE OF ACTION (Check one item only For a UST closure or removal,complete only this section and Sections 1,11,111,!V,and IX below) VU 430 <br /> ❑ I NEW PERMIT ❑ 3 RENEWAL PERMIT ® 5 CHANGE OF INFORMATION <br /> ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL <br /> DATE UST PERMANENTLY CLOSED: 4306 I DATE EXISTING UST DISCOVERED: a3ob <br /> I. FACILITY INFORMATION <br /> FACILITY ID#(Agency Use Only) - - s '7 u I <br /> BUSINESS NAME(Same as Facility Name of DBA-Doing Business As) 3 <br /> CRLLC #2705447 <br /> BUSINESS SITE ADDRESS 107 CITY 104 <br /> 1469 E. Hammer Lane Stockton, CA 95210 <br /> II. TANK DESCRIPTION <br /> TANK ID# 432 TANK MANUFACTURER 433 TANK CONFIGURATION:THIS TANK IS 434 <br /> /" 1 A STAND-ALONE TANK Complete one page for each <br /> 1 -7f' ft' {� ❑ 2.ONE IN A COMPARTMENTED UNIT compartment in the unit. <br /> DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 637 <br /> 3/31/1998 10,563 f <br /> II. TANK USE AND CONTENTS <br /> TANK USE ® la MOTOR VEHICLE FUELING ❑ Ib MARINA FUELING ❑ 1 AVIATION FUELING 439 <br /> ❑ 3 CHEMICAL PRODUCT STORAGE ❑ 4 HAZARDOUS WASTE(Includes Used Oil) ❑ 5 EMERGENCY GENERATOR FUEL[HSC§25281 5(c)] <br /> ❑ 6,OIHER GENERATOR FUEL [] 95.UNKNOWN [199.OTHER(Specify): 439a <br /> ....... ....... OLE- <br /> ...._._.....___............-._-__-_ .-............-............. ...................._...I._,.........._._._._..................._ ...- ---._..__.._.._._._.. 440 <br /> CONTENTS PETROL..EUM: ❑ la REGULAR UNLEADED C] Ic MIDGRADE UNLEADED ❑ lb PREMIUM UNLEADED <br /> ❑ 3 DIESEL ❑ 5 JET FUEL ❑ 6.AVIATION GAS <br /> [3 8.PETROLEUM BLEND FUEL ® 9.OTHER PETROLEUM(Specify): (11x1(.1=/kY)m f7w S 4606 <br /> NON-PETROLEUM: <br /> in 7 USED OIL ❑ 10 ETHANOL <br /> ❑ 11.OIHER NON-PETROLEUM(Specify): aaob <br /> IV. TANK CON$T t -_ TION. <br /> TYPE OF TANK ❑ 1 SINGLE WALL ® 2 DOUBLE WALL 0 95_ N 443 <br /> _ UNKNOWaia <br /> PRIMARY CONTAINMENT ❑ 1 STEEL ® 3.FIBERGLASS ❑ 6 INTERNAL BLADDER <br /> C17.SIEEL+INTERNAL LINING [195yUNKNOWN [1 99 OTHER(Specify): aaaa <br /> SECONDARY CONTAINMENT ❑ t STEEL ®3 FIBERGLASS ❑ 6 EXTERIOR MEMBRANE LINER ❑ 7 ,JACKETED 445. <br /> ❑ 90.NONE ❑ 95,UNKNOWN ❑99 OTHER(Specify): 4656 <br /> OVERFILL PREVENTION IiBL <br /> 1 AUDIE&VISUAL ALARMS ❑ 2 BALL FLOA1.T 3 FILL TUBE SHUT-OFF VALVE 452 <br /> ❑ 4 TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVER LL REVENTION EQUIPMENT <br /> V. PRODUCT/WASTE PIPING CONSTRUCTION <br /> PIPING CONSTRUCTION ❑ 1 SINGLE WALL ® 2 DOUBLE WALL ❑ 99 OTHER 460 <br /> 1 PRESSURE 2 TT <br /> GRAVY_ ❑ 3-.-CONVENTIONAL SUCTION [,_34 SAFE SUCTION[z3 CCR 36(a 3)] <br /> ass <br /> - 464 <br /> PRIMARY CONTAINMENT ❑ l STEEL ® 4 FIBERGLASS ❑ 8 FLEXIBLE ❑ 10 RIGID PLASTIC <br /> _ ❑ 90 NONE 95 UNKNOWN ❑ 99.0IHER(Specify_): 464a <br /> . ......._.... .. .. 4646 <br /> SECONDARY CONTAINMENT ❑ 1 STEEL ® 4 FIBERGLASS ❑ 8 FLEXIBLE ❑ 10 RIGID PLASTIC <br /> ❑ 90,NONE C.I. 95.UNKNOWN ❑ 99 OTHER(Specify): 464c <br /> PIPING/TURBINE CONTAINMENT SUMP TYPE IPI.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464d <br /> VI. VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION <br /> VENT PRIMARY CONTAINMENT ❑ 1 STEEL ® 4.FIBERGLASS ❑ 10 RIGIDPLASTIC [1ecif <br /> ( P Y)� 4641190.NONE ❑ 99 OTHER S 664.1 <br /> . <br /> ...,,......_.. -__ -... __ .__._ ._...... _ - _ _ ..._. ._. . .. _... - ....._. .. _464f <br /> VENT SECONDARY CONTAINMENT ❑ 1 STEEL ❑ 4.FIBERGLASS ❑ 10 RIGIDPLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 4601 <br /> VR PRIMARY CONTAINMENT ❑ 1 STEEL ® 4.FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): gbgggj <br /> VR SECONDARY CONTAINMENT ❑ 1 SIEEL ® 4 FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 90 NONE ❑ 99 OTHER(Specify): 46ah <br /> -- <br /> ---- -­.-.... ...... ................_..-........-.... .. ......... __.. <br /> VENT PIPING TRANSITION SUMP TYPE C] I SINGLE WALL El DOUBLE WALL ® 90 NONE 464 <br /> __. <br /> ..... _. ........................... ........__._.. ._ _.. 464 <br /> RISER PRIMARY CONTAINMENT ® 1 STEEL ❑ 4.FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 90.NONE ❑ 99 OTHER(Specify): a64i1, <br /> ....._. .._...._ ._. _..._.... __.._._... .. _ _ _. _... <br /> RISER SECONDARY CONTAINMENT ❑ 1 STEEL ❑ 4 FIBERGLASS ❑ 10 RIGID PLASTIC ® 90 NONE ❑ 99 OTHER(Specify): 46ak1. <br /> _-- ._._.._.. _...._.._.._._ ..-- -.. ......_. _..-.._-._.._ _ ----_....-. . . ............. Ni- ._ _.. <br /> FILL COMPONENTS INSTALLED ® 1 SPILL BUCKET 3.STRIKER PLATEJBOTTOM PROTECTOR ❑ 4.CONTAINMENT SUMP a-c <br /> VII. UNDER DISPENSER CONTAINMENT (UDC) <br /> CONSTRUCTION TYPE- ® I SINGLE WALL ❑ 2 DOUBLE WALL ❑ 3 NO DISPENSERS ❑ 90.NONE 469a <br /> - ---- -, . ... .... 46% <br /> CONSTRUCTION MATERIAL ❑ I STEEL. ® 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 648 <br /> IX. APPLICANT SIGNATURE <br /> CERTIFICATION: I certify t thi S7 system ' compatible with the hazardous substance stored and that the information provided herein is true, <br /> accu e,and f om li with lea eVrements. <br /> ago <br /> APPLICANT SIGNA RE DATE _ r� <br /> Iffv'f <br /> APPLICANT NAME pnnt) C1TUC Oft1C11 471 APPLICANT TITLE Manager Of Compliance & Malnt. 472 <br /> UPCF UST-B Rev.(12/2007)-1/2 www.unidocs.org <br />