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UNIFIED PROGRAM CONSOLIDATED FORM <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 I,II,III,IV,,and IX below) 1-0 �- �30. <br /> [:11.NEW PERMIT [:13.RENEWAL PERMIT ® 5.CHANGE OF INFORMATION ' 7 <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) _ _ 1. <br /> BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3. <br /> CRLLC/76#5447 <br /> BUSINESS SITE ADDRESS 103. 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 /> 4 Unknown ® 1.A STAND-ALONE TANK Complete one page for each <br /> ❑ <br /> 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 437• <br /> 3/31/1998 10,563 <br /> III. TANK USE AND CONTENTS <br /> TANK USE ® la.MOTOR VEHICLE FUELING ❑ lb.MARINA FUELING ❑ ]c.AVIATION FUELING 439. <br /> ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§25281.5(c)I <br /> ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(Specify) 439& <br /> CONTENTS PETROLEUM:--❑ la.REGULAR UNLEADED ❑ ic.MIDGRADE UNLEADED ❑ lb.PREMIUM UNLEADED 440. <br /> ® 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS <br /> ..... ............. _._.._. ____ Q 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM(Specify): 440& <br /> NON-PETROLEUM:❑ T USED OIL ❑ 10.ETHANOL <br /> ❑ 11.OTHER NON-PETROLEUM(Spcci ): 440b. <br /> jV. TANK CONSTRUCTION <br /> TYPE OF TANK --❑ L SINGLE WALL ® 2.DOUBLE WALL_ ❑ 95.UNKNOWN - -_ 443. <br /> PRIMARY CONTAINMENT ❑ 1.STEEL ® 3.FIBERGLASS ❑ 6.INTERNAL BLADDER -- - 444. <br /> _.._.._._..---...-----------------__-_0 7.STEEL+INTERNAL-LINING---- _......_._..__.._._0 95.UNKNOWN -❑ 99_OTHER(Specify): 444& <br /> SECONDARY CONTAINMENT ❑ 1.STEEL ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445. <br /> ...90.90 NONE _..__._.._.....__.95.UNKNOWN- --0 99.OTHER(Specify)_ 445& <br /> OVERFILL PREVENTION 11 1.AUDIBLE&VISUAL ALARMS ❑ 2.BALL FLOAT ❑ 3.FILL TUBE SHUT-OFF VALVE 452. <br /> 04.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 ❑ 4:SAFE SUCTION�3 CCR§z636(ax3)� - 458_ <br /> PRIMARY CONTAINMENT ❑ L STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464. <br /> -...._...__ - ❑ 90.NONE -❑ 95.UNKNOWN---- --[1 99,OTHER(Specify): 464& <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 ® 90.NONE a6ad. <br /> ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL <br /> VI. VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION <br /> VENT PRIMARY CONTAINMENT ❑ l STEEL ® 4 FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 464e. <br /> - _...--.................--- ---_-._. ....,. -._._ ..... .... ....._... ................. 464e1. <br /> VENT SECONDARY CONTAINMENT ❑ 1 STEEL ® 4 FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 4640 <br /> ------'-------------------- -- -'---.........---... .--`------ ---------- -------------------------..._....-----._.._..-.-._.._._.......-_---._..........-..._P............... 464fl. <br /> VR PRIMARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 464g' <br /> --------------------------............_........._.----.-.-.-_._..--------.._-------------------.._._._....._...................--.............._--........._.._._._._._._._......_._.-._._._.._-._._.._..._..-----..___.._.-_ 464 1. <br /> VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 464h. <br /> ._.__.._--._.._.__..._._............_--....--------._--.......-----...--'------'--'-------------------............-._..-._-.....-_......__......................._..---.._....-__--....-....----...-.._._._._...---------..........------_...-.--.......--- 464hl. <br /> VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE 4641. <br /> - -- -- --- ------ --- --- ----- ----.._. __... ..-- .._.... _ .._.. ._. .---.... <br /> RISER PRIMARY CONTAINMENT ❑ L 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.OTHERS eci 464k. <br /> ( P �) 464kl. <br /> FILL COMPONENTS INSTALLED ® I.SPILL BUCKET ❑ 3.STRIKER PLATE/BOTTOM PROTECTOR ❑ 4.CONTAINMENT SUMP 45la-c. <br /> VII. UNDER DISPENSER CONTAINMENT (UDC) <br /> CONSTRUCTION TYPE ❑ I SINGLE WALL ❑ 2 DOUBLE WALL ® 3 NO DISPENSERS ❑ 90.NONE 469a. <br /> CONSTRUCTION MATERIAL ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 469b. <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 470. <br /> APPLICANT NAME(print) Allen FaaSS 471. APPLICANT TITLE472. <br /> California Compliance Manager <br /> UPCF UST-B Rev.(12/2007)-1/2 www.unidocs.org <br />