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UNIFIED PROGRAM CONSOLIDATED FORM 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,11,111 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: 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. CITY 104. 1469 E. Hammer Lane Stockton II. TANK DESCRIPTION TANK ID# 432. TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434. 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 III. TANK USE AND CONTENTS TANK USE ® la.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ ]c.AVIATION FUELING 439. ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§25281.5(c)) - --Q_6:.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(Specify)_ 439. ........_ ...... -. -- ...--...._..._......----- ... . _............----- CONTENTS PETROLEUM: Ella.REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ❑ lb.PREMIUM UNLEADED 440. ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ® 9.OTHER PETROLEUM(Specify)_-UNLEADED PLUS 440. 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): 444. ---- -- -_.._ .. _ _ SECONDARY CONTAINMENT El1.STEEL ®3.FIBERGLASS ❑ 6 EXTERIOR MEMBRANE LINER [17.1ACKETED 4 4 5. ❑ 90.NONE ❑ 95.UNKNOWN ❑99.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 OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION - - ❑ I.SINGLE WALL ❑ 2_DOUBLE,WALL ❑ 99.OTHER 460. -._ - - ... -------------- -'- ---- .. SYSTEM TYPE ❑ 1 PRESSURE ❑ 2.GRAVITY ❑ 3 CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION t CCR§2636(4)(3)1 PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464. ❑ 90.NONE ❑ 95.UNKNOWN [399.OTHER(Specify): 464. ----------- -.._.....-------- ._._._....._._._.._._............._....._.._._....- ----------------------------' ----- 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 ❑ 2.DOUBLE WALL 4644. ❑ 1.SINGLE WALL ® 90.NONE VI. VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC [190.NONE [199.OTHERS eci 464e. ( P �) 464el. VENT SECONDARY CONTAINMENT ❑ 1.STEEL 4.FIBERGLASS ❑ 10.RIGID PLASTIC El 90.NONE [199.OTHER S eci 464f. ( P �') 464f1._ VR PRIMARY CONTAINMENT ❑ 1.STEEL U 4.FIBERGLASS ❑ 10.RIGID PLASTIC 90.NONE ❑ 99.OTHER(Specify): 44648 -.._........ ----._..... ------ -.._._.._...._._.-_._........_._..--- -'----------------______._.._._._.-._.._.__._._._..._....._._._.__._._._._._........._....._.._...._ --- ....................._...... ----- VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHERS eci 464h. -----------..--- --- ._._._._._...._....------._.-.._.._---------- -------- - -------- ( P fY) VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE 464i. -- --- ._.. ........... _ ._..---------- .... _..._-..._ -....- .. - --- ----- -' -------------- . - .._. - - .......... -------- RISER PRIMARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC 90.NONE ❑ 99.OTHER(Specify): 4641. (S P �) 464'1. RISER SECONDARY CONTAINMENT ❑ 1.STEEL y❑ 4.FIBERGLASS_ ❑ 10.RIGID PLASTIC__® 90.NONE ❑ 99.OTHER(Specify):): 464k. _ 464k1. FILL COMPONENT$INSTALLED ® I.SPILL BUCKET ❑ 3.STRIKER PLATE/BOTTOM PROTECTOR-� ❑ 4.CONTAINMENT SUMP 45la-c. VII. UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE 1.SINGLE WALL 469a. -._.._...------------------------0 1. -- --------------........._.__...._02.DOUBLE WALL 3_NO DISPENSERS--- 90 NONE._...... CONSTRUCTION MATERIAL ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 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 / 470. APPLICANT NAME(print) Allen FaaSS 471. APPLICANTTITLE California Compliance Manager 472. UPCF UST-B Rev.(12/2007)-1/2 www.unidocs.org