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I i UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION (One form per UST) ITYPEOFACTION (Check one item only Fat a UST closure w removal,complete only this section and Sections 1,Il,111,IV,and IX below) 430 ❑ 1 NEW PERMIT ❑ 3 RENEWAL PERMIT ® 5 CHANGE OF 114FORMA'[[ON s ❑ 6.TEMPORARY USI CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE 8.UST REMOVAL _ DATE UST PERMANENTLY CLOSED: 430. 1 DATE EXISTING UST DISCOVERED: asob i _ I. FACILITY INFORMATION _ FACILITY ID#(Agency Use Only) - { BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3 CRLLC#2705447 BUSINESS SITE ADDRESS 1m CITY 104 A 95210 1469 E. Hammer Lane Stockton, C��_ _ Ii. TANK DESCRIPTION TANK ID# 432 TANK MANUFACTURER 433 TANK CONFIGURATION THIS TANK IS 434 _ _ A SIAND-ALONE TANK Complete one page ror each j ❑ 2.ONE INA COMPARIMENTED UNIT compartment in the unit DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 433 3/31/1998 10,563 _ 1 ., 1 III T�114 L1SE AND CNTTS - 439 TANK USE ® la MOTOR VEHICLE FUELING ❑ 1b MARINA FUELING ❑ is AVIATION FUELING ❑ .3 CHEMICAL PRODUCT STORAGE ❑ 4 HAZARDOUS WAS IE(Indudes Used Oil) ❑ 5 EMERGENCY GENERATOR FUEL 13-ISC§25281 5(01 __ 0 6.01 HERR GENERATOR FUEL .._-_._..-._0 95:UNKNOWN _ _ -._-- n 99;OIHER(smM' 439. CONTENTS PETROLEUM: ❑ la REGULAR UNLEADED ❑ lc MIDGRADE UNLEADED lb PREMIUM UNLEADED aao 3 DIESEL ❑ 5 FET FUEL 1] 6 AVIATION GAS 440. ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM(Specify): NON-PETROLEUM:(5 7 USED OIL ❑ l0 ETHANOL ❑ 11.OIHER NON-PETROLEUM(Specify): 4406 TYPE OF TANK_ [31.SINGLE_WALL_ ® 2 DOUBLE WALL_ ❑ 95.UNKNOWN 443 PRIMARY CONTAMMENT ❑ 1 STEEL ® 3 FIBERGLASS ❑ 6 INTERNAL BLADDER 4aa _ _ _ _ .. 4µa ' _ _ 7 STEEL INTERNAL LINING ❑ 95.UNKNOWN _0 99.OIHER(SpeciM. - ; 445 SECONDARY CONTAINMENT ❑ 1 STEEL ®3•FIBERGLASS ❑ 6 EXTERIOR MEMBRANE LINER ❑ 7 IACKETED i ❑ 90.NONE ❑ 95.UNKNOWN ❑99 OTHER(Specify): _ -•.___.. ._._..----.--... _._...---_ -.------------._. _._ _ ._._._ 9 FILLTUBESHUT-OFF VALVE OVERFILL PREVENTION ❑ 1 AUDIBLE&VISUAL ALARMS ❑ 2 BALL FLOAT 452 ❑ 4.IANK MEETS RE UIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTI_6 LE I a NO I � . h. �` 1if-F4.._ - _• _ - PIPING CONSTRUCTION_ 0 I SINGLE WALL ® 2 DOUBLE WALL p 99.OTHER 46a 1 -- - -- _ - _.-.. _ _ __ is- 4 SYSTEM TYPE 1.PRESSURE ❑ 2.GRAVITY 3 CONVENTIONAL SUCTION ❑ 4;SAFE SUCTION X23 CCR2636(a)(7)� PRIMARY CONTAINMENT ❑ 1 STFEt ® 4 FIBERGLASS ❑ 8 FLEXIBLE - ❑ 10 RIGID PLASTIC a64 _ _ _ __ ❑ 90.NONE _❑ 95.UNKNOWN ❑ 99 OTHER(Specit�). 464a f _ - .___ "-_. "._-_- .•- 4646 I �.. SECONDARY CONTAINMENT ❑ 1 STEEL ® 4 FIBERGLASS ❑ 8 FLEXIBLE ❑ 10 RIGID PLASTIC ❑ 90.NONE ❑ 95 UNKNOWN ❑ 99 OTHER(Specify) _! a64c __ -- -- --- - - - 5-- PIPMG/TURBINE CONTAINMENT SUMP TYPE 1.SINGLE WALL_ ❑ 2 DOUBLE WALL ❑ 90.NONE viN'r,� oR RECORY( ).Arno xs�R I•��I, . PIPING CONSTREJCTIf1N VENT PRIMARY CONTAINMENT ❑ 1 STEEL ® 4 FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 90 NONE ❑ 99 OTHER(Specify): _ 464cI VENT SECONDARY CONTAINMENT ❑ 1 STEEL ❑ 4 FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 90.NONE ❑ 99,OTHER(Specify): 464n VR PRIMARY CONTAINMENT ❑ 1 STEEL ® 4.FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 90 NONE ❑ 99 OTHER(Specify): 4 : VR SECONDARY CONTAINMENT [31 STEEL ® 4 FIBERGLASS [3 10 RIGID PLASTIC EP NONE 1.199 OTHER(Specify): 46�j, ..-,_.._...____... ................. ....._- - ._. .. 464/ VENT PIPING TRANSITION SUMP TYPE ❑ 1 SINGLE WALL ❑ 2 DOUBLE WALL ® 90 NONE I RISER PRIMARY CONTAINMENT 0 1 STEEL ❑ 4 FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 90 NONE ❑ 99 01HER(Specify): 4ea4i I RISER SECONDARY CONTAINMENT ❑ t STEEL ❑4 FIBERGLASS ❑ 10 RIGID PLASTIC ® 90 NONE ❑ 99 OTHER(Specify): 4601 I FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET 3.STRECER PLATE/BOTTOM PROTECTOR [34.CONTAINMENT SUMP 451 a c I. UNDER DIS E1'�SEI GOiNTAINNT(UDC) - CONSTRUCTION TYPE _ ® 1 SINGLE WALL ❑ 2 DOUBLE WALL 90,NONE 469146sb (( CONSTRUCTION MATERIAL ❑ t STEEL ® 4 FIBERGLASS ❑ 10 RIGIDPLASTIC ❑ 99 OTHER(Specify) 469c. I VIII. CORROSION PROTECTION _ STEEL COMPONENT_PROTECTION ❑ 2 SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION 448 IX. APPLICANT SIGNATURE CERTIFICATION: I certify that this; !tem'4' compatibl th the hazardous substance stored and that the information provided herein is true, accurate r 11 lia ith IcR0,54hrements. ago � APPLICANT SIGNATUREa -- DATE aJ 471 APPLICANT T 1T LE --� 4n APPLICANT NAME(print) Chuck J. Oftich Manager of Compliance&Maint. UPCF UST-B Rev.(12/2007)-1/2 www.unidocs.org