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UNIFIED PROGRAM CONSOLIDATED FORM <br /> UNDERGROUND STORAGE TANK t to <br /> OPERATING PERMIT APPLICATION-TANK INFORMA ON (One form per UST) <br /> ITYPEOFACTION (Check one item only. For a UST closure or removal,complete only this section and Sections I,II,III,IV,and IX below) 430. <br /> ❑ 1.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: 430a 1 DATE EXISTING UST DISCOVERED: 4306. <br /> I. FACILITY INFORMATION <br /> FACILITY ID#(Agency Use Only) _ _ 11 <br /> BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3. <br /> CRLLC/76#5447 <br /> BUSINESS SITE ADDRESS 103. 1 CITY 104. <br /> 1469 E. Hammer Lane Stockton <br /> II. TANK DESCRIPTION <br /> TANK ID# 432. TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434. <br /> 1 Unknown ® 1.A STAND-ALONE TANK Complete one page for each <br /> ❑ 2.ONE IN A COMPARTMENTED UNIT compartment in the wit. <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 ❑ Ib.MARINA FUELING ❑ Ic.AVIATION FUELING 439. <br /> ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§25281.5(,)] <br /> ❑ 6.OTHER GENERATOR FUEL ❑ 95'UNKNOWN __ 439a <br /> ❑ 99.OTHER(Specify): <br /> CONTENTS PETROLEUM: ® la.REGULAR UNLEADED ❑ lc.MIDGRADE UNLEADED ❑ 1b.PREMIUM UNLEADED 440. <br /> ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS <br /> .._........ <br /> [1 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM(Specify): 44oa <br /> .........._......._._...._-.........._.__.__..__...... _ <br /> NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL .._._._.. <br /> ❑ 11.OTHER NON-PETROLEUM(Specify): 440b. <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 444. <br /> ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 444x. <br /> SECONDARY CONTAINMENT [31.STEEL ®3.FIBERGLASS [16.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445. <br /> _0 90.NONE_ _ ❑ 95.UNKNOWN [199.O_THER_(Specify): 445a. <br /> OVERFILL PREVENTION ❑ 1.AUDIBLE&VISUAL ALARMS ❑ 2.BALL FLOAT ❑ 3.FILL TUBE SHUT-OFF VALVE 452. <br /> ® 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT <br /> V. PRODUCT/WASTE PIPING CONSTRUCTION <br /> PIPING CONSTRUCTION ❑ 1_SINGLE WALL ❑ 2,DOUBLE WALL ❑ 99.OTHER _ _ _ 460. <br /> SYSTEM TYPE -- - - ❑ 1.PRESSURE -. ❑ 2 GRAVITY ❑ 3 CONVENTIONAL SUCTION ❑1-4--S SUCTION[z3 CCR§2636(a)S3)1 -458. <br /> PRIMARY CONTAMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464• <br /> IN <br /> _ ❑ 90.NONE _❑ 95.UNKNOWN _❑ 99.OTHER(Specify): 464x. <br /> SECONDARY CONTAINMENT ❑ 1.STEEL - ® 4.FIBERGLASS ❑ 8.FLEXIBLE-- ❑ 10.RIGID PLASTIC _ 4646. <br /> ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c. <br /> PIPING/TURBINE CONTAINMENT SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE <br /> VI VENT,VAPOR RECOVER , ,{ �' <br /> .�1ND RISER/FILL PIPE PIPING CONSTRUCTION <br /> VENT PRIMARY CONTAINMENT ❑ 1 STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 464e. <br /> VENT SECONDARY CONTAINMENT ❑ 1..STEEL ® 4 FIBERGLASS ❑ I0.RIGID PLASTIC ❑ 90_NONE ❑ 99, 4f <br /> .OTHER(Specify): 464n r <br /> 46 <br /> VR PRIMARY CONTAINMENT ❑ 1 STEEL ❑ 4 FIBERGLASS464g. <br /> ❑ ]0.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 464 I <br /> VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 464hl. <br /> VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE 4641 <br /> -------------------- ....- - ._._..._.....__.._._.. ...._.............._.._._.... ---------------._._...---------------------._._...----------.._._....-------- <br /> .._.__._..................._._.._.........._..-.._._..._._.__._._._.._.__........------ ._._.._._. <br /> t RISER PRIMARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 4464j. <br /> RISER SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 46441. <br /> FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET ❑ 3.STRIKER PLATE/BOTTOM PROTECTOR ❑ 4.CONTAINMENT SUMP 45l a-c. <br /> VII. UNDER DISPENSER CONTAINMENT(UDC) <br /> CONSTRUCTION TYPE 1.SINGLE WALL ❑ 90.NONE _ <br /> _� _ ._ .---.-_-._ _� 2 DOUBLE WALL ® 3.NO DISPENSERS 469a.' <br /> CONSTRUCTION MATERIAL ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 4696. <br /> 469c, <br /> VIII. CORROSION PROTECTION <br /> ' STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION 448. <br /> IX. APPLICANT SIGNATURE <br /> CERTIFICATION: I certify that this UST system is compatible with the hazardous substance stored and that the information provided herein is true, <br /> accurate and in full compliance with legal requirements. <br /> APPLICANT SIGNATURE DATE �WV 470. <br /> APPLICANT NAME(print) Allen FaaSS 471. APPLICANT TITLE California Compliance Manager 472. <br /> UPCF UST-B Rev.(12/2007)-1/2 www.unidocs.org <br />