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UNIFIED PROGRAM CONSOLIDATED FORM C UNDERGROUND STORAGE TANK / �^ eP,430.OPERATING PERMIT APPLICATION-TANK INFORMATION (One form pe TYPE OF ACTION (Check one item only. For a UST closure or removal,complete only this section and Sections I,II,III,IV,and IX below) �s1.NEW PERMIT ❑ 3.RENEWAL PERMIT ® 5.CHANGE OF INFORMATIONJ ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 430& 1 DATE EXISTING UST DISCOVERED: 430b. I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) _ _ 1. BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3. CRLLC/76#5447 BUSINESS SITE ADDRESS 103. 1 CITY 104. 1469 E. Hammer Lane Stockton II. TANK DESCRIPTION TANK ID# 432. TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434. 2 Unknown ® 1.A STAND-ALONE TANK Complete one page for each ❑ 2.ONE IN A COMPARTMENTED UNIT compartment in the wit. DATE UST SYSTEM INSTALLED 435. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS IN THE UNIT 437 3/31/1998 10,563 III. TANK USE AND CONTENTS TANK USE ® la.MOTOR VEHICLE FUELING ❑ lb.MARINA FUELING ❑ Ic.AVIATION FUELING 439. ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC 025281.5(c)] ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 439a. .._....._....._.._.._-....._......_._.. _...._..... _ . ......_.-._.... ..._...-D ® Ib.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 . ❑ 11.OTHER NON-PETROLEUM(Specify): 440b IV. TANK CONSTRUCTION TYPE OF TANK 1.SINGLE WALL ® 2 DOUBLE WALL 95_UNKNOWN _.... __._. __ 443. - --- - PRIMARY CONTAINMENT ❑ L STEEL ® 3.FIBERGLASS ❑ 6.INTERNAL BLADDER - 444 7.STEEL+INTERNAL_ LINING ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 444a. SECONDARY CONTAINMENT ❑ 1.STEEL ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445. __.____________._...._.____._.._._._.._.___...._._-..._... .❑ 90.NONE ❑ 95.UNKNOWN [199.OTHER(Specify): 445& ................_........._.._._._........_._.. ...__----- - ---------...._.....-------------------------------------- _. OVERFILL PREVENTION ❑ 1.AUDIBLE&VISUAL ALARMS ❑ 2.BALL FLOAT ❑ 3.FILL TUBE SHUT-OFF VALVE 452. ® 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION I SINGLE WALL ❑ 2.DOUBLE WALL ❑ 99 OTHER 460. .. -- . SYSTEM TYPE _...__.. -2636----- --- _ ❑ 1 PRESSURE ❑ 2 GRAVITY __ ❑ 3 CONVENTIONAL SUCTION ❑ 4 SAFE SUCTION[23 CCR 12636(a)(3)] 458.. PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464& - ----- - ._...._......_.._._......-----._..........._...._._._---_.......---------._..._.....2222 ._._..-------- - SECONDARY CONTAINMENT ❑ L STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464b. 90_NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c. ._._._............._.._..--..................._._....._._.-.-.._.. .._...._...----._._...-----.__........... . 4d. VI. VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 4We' �) 464e1. . ._.. ....... - .__...._.. . .-- ..................... ... .............. _............ ..... ......_-_ ....__.._._._ - _.....--_-_.. '-____.-...__.... VENT SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER S eci 464f. _... 2222--- 2222 ----__.... .............. (Specify): 464fl. VR PRIMARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS [110.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER S ec -4Mg. (Specify): 464 1. VR SECONDARY CONTAINMENT ❑ L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 464h. ............ .-........_.. ............. .. ........._._..... ..._..._......... 464 1. VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE 464i. ......... ..... ........... .._ - .... __-------. ._......._. _. ... ...._.... _._._...... _..... _ .._.._._...._ .... 464. RISER PRIMARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 464'1 RISER SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 46441. FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET ❑ 3.STRIKER PLATE/BOTTOM PROTECTOR ❑ 4.CONTAINMENT SUMP 45la-c. VII. UNDER DISPENSER CONTAINMENT(UDC) 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) 4696. 469c. VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION 448. IX. APPLICANT SIGNATURE 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 with legal requirements. APPLICANT SIGNATURE ; DATE Q' 47°. APPLICANT NAME(print) AI en FaaSS 471. APPLICANT TI LE California Compliance Manager 472. UPCF UST-B Rev.(12/2007)-1/2 www.unidocs.org