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UNIFIED PROGRAM CONSOLIDATED FORM -71 p m jl UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION (One form per UST) TYPE OF ACTION (Check one item only. For a UST closure or removal,complete only this section and Sections I,11111 IV,and IX below) 430. ❑ 1.NEW PERMIT ❑ 3.RENEWAL PERMIT ® 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 430a DATE EXISTING UST DISCOVERED: 4306. I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) -71 1 If BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3. CRLLC#2705447 BUSINESS SITE ADDRESS 103. CITY 104. 1469 E. Hammer Lane I Stockton II. TANK DESCRIPTION TANK ID# G 7� 432. TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434. 5 _ 3 Unknown ® 1.A STAND-ALONE TANK Complete one page for each ❑ 2.ONE IN A COMPARTMENTED UNIT compartment in the unit. DATE UST SYSTEM INSTALLED 435, TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS IN THE UNIT 437. 3/31/1998 10,563 i III. TANK USE AND CONTENTS TANK USE ® la.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ lc.AVIATION FUELING 439. ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§25281.5(c)] ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 439a. CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED ❑ ]c.MIDGRADE UNLEADED ❑ lb.PREMIUM UNLEADED 440. ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ® 9.OTHER PETROLEUM(Specify): UNLEADED PLUS 440a NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 4406. IV TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 95.UNKNOWN 443. PRIMARY CONTAINMENT ❑ 1.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): 445a. OVERFILL PREVENTION ❑ 1.AUDIBLE&VISUAL ALARMS ❑ 2.BALL FLOAT °3.FILL TUBE SHUT-OFF VALVE 452. ® 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILLPREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION „❑ 1.SINGLE WALL 1&2.DOUBLE WALL ❑ 99 OTHER 460. SYSTEM TYPE 1 PRESSURE ❑ 2 GRAVITY ❑_3 CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR§2636(a)(3)1 , 458. .... ......_ . ..... PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464. _11-11111- ❑ 90. . ............. . _ ._..__.._.... SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 4646. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c. . ... ......... ....._ .. .._...... ...... ...... . .....__ PIPING/TURBINE CONTAINMENT SUMP TYPE 1.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE 464d. VI. VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC [190.NONE [199.OTHER(Specify): 4664Mej . _ ........- .. ......., _._ VENT SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99 OTHER(Specify): 464fl. VR PRIMARY CONTAINMENT ❑ 1 STEEL 4.FIBERGLASS ❑ 10 RIGID PLASTIC 0.NONE ❑ 99 OTHER(Specify) 4644S1. VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 464hl. .. -_-............._._..------.....__....._..__._..._____.__.....__.._....._......_....._..._...._._..__......._....._...._....-......_....--_...----.. _.._...__..._.__._._......_...__...__....._......__..._.__._....._....._...__..... _._....__..._............. VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE 4M' RISER PRIMARY 11 CONTAINMENT ' L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC X90.NONE ❑ 99.OTHER(Specify): g464j 464j. RISER SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 464k1 __..._�.._-.-_.- __.....__..._...._..---.....-_._.�----- �. _. _. _.._-...-... ..._.__..._....._....._.-...__._......_....__... _..._.. 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 .NO DISPENSERS ❑ 90.NONE 469a. _....._..__.__...-_...._._...___..._........ _.._..__..._......_-.__.....__....__....._..... ....._....__..........._......__._....._....... - ._... .._.....----.....__._... ...__....._.....__..._..._.. _....._.._. __....._.............._.._._....._...._.......__....._......_......_.......... U 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 4696. CONSTRUCTION MATERIAL ' �{� (SPe fY) 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' full compliapco4vitkLegal requirements. azo. APPLICANT SIGNATURE DATE APPLICANT NAME(print) Armen Mkrtyc Ian 471 APPLICANT TITLE California Compliance Manager 472 UPCF UST-B Rev.(12/2007)-1/2 www.unidocs.org