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UNII��D PROGRAM CONSOLIDATED FORM
<br /> UNDERGROUND STORAGE TANK
<br /> OPERATING PERMIT APPLICATION-TANK INFORMATION (one farm Pa um
<br /> TYPE OF ACTION (Check one item only For 4 UST closers or remova4 complete oily this section and Secdons I,77,III,IIS;and I,Y below) 430.
<br /> ❑ 1.NEW PERMIT 3.RENEWAL PERMIT ❑ S-CHANCrE O'F INFORMATION
<br /> 6,TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON s= ❑ S-UST REMOVAL
<br /> BATE UST PERMANENTLY CLASED: 430a 1 DATE=STING UST DISCOVERED' 430b.
<br /> T. i'ACTLTTY mFoRMATXVN
<br /> FACILITY ID (agency Use Only)
<br /> BUSINESS NAME(Same as FacilitylVame orL?BA-mmngBllmessAs) 3.
<br /> BONF.A,RE MARKET#35
<br /> FrUSINESS SITE ADDRESS a3. CITY 2047,
<br /> 15 R CiRANTT.Ti�,E RD. TRACY
<br /> JOL TAINK DESCRIPTION
<br /> TMNID# -� 4az TANK MANUFACTURER 433- TANK CONMURraTION:TELLS TANIC IS 434 -!
<br /> TA 0140405 MODERN\T'WELDING ❑ 1,A STAND]ALONL TANK CompI to ow pagt fiK coal,
<br /> I]A UST SYSTEM INSTALLED 43s. a ONE IN A COaARTMENTED tWIT id 63c w
<br /> TANIt CAPACITY IN'GALLONS 436. NLN43 ER OF COMPARTMENTS IN TFIE UNIT 437.
<br /> 3-1-1988 12,000
<br /> 119L. TAyNK IJ SE"ASND.CONTENTS .
<br /> .
<br /> TANK USE Ia.MCToR VEHICLE FU)L WG ❑ 1b.MARINA FLZLING ❑ 1c,AVIATION rJSI.,ING 439.
<br /> ❑ 3,CBMIIICAI,PRODUCT STOP-AGE ❑4.BAZARDOUS'WASTT,Qncmd,8U,.doo) ❑ 5.EIvE,RGETlCY(3IK�RATORFUEL VRsC§252&i5(.
<br /> yl
<br /> ❑ 6.OTR R GENER4TORFUEL C] 95.UNLCNOWN ❑ 99.OTHSR(Spc )- C91L
<br /> CONTENTS PETROLEUM: C] 1&REajLARXJNLEADED ❑ Ic MIDG1ZApELJAIInA17 D ® Ib.PRW4IUMUNtEADED 440.
<br /> ❑ 3,DIESEL ❑ %JET FUEL, [3 6.AVIATION GAS
<br /> ❑ S.PETROLEUMBLYNDFUEL. ❑A OTWRPETTROLSJAI(Specify): 44U
<br /> NON-PETROLEUM:0 7.USED OIL El 10.ETHANOL
<br /> ❑ IIIOTT3ERNOAI,BST7ROLEU�d 3 44%.
<br /> IV. T NR Cp
<br /> TI UC
<br /> NSTA ON..
<br /> TYPE OF TANK ❑ 1.SINGLE WALL ®2 DOUBLE WALL ❑ 95-17�W'JOWN a43,
<br /> PRIMARY CONNTAIIJMENT .® 1.STEEI, 113.FIBERGLASS ❑ 6.TONAL BLADDER 4qa,
<br /> ❑ 7.STEEL+IN7MMAL LINING ❑ 95.=4KNOWN ❑99.OTHER(Spe ' ); 444a
<br /> SECONDARY CONTAINMENT 1.STsEL ❑3.FIBERGLASS ❑ 6.EXTERIORMEMBRANELINER ❑ 7.SACKETED 445.
<br /> _ 90.NONE 1395.VN=OWN [199,OTHER(Specify_): 445&
<br /> OVER)rLL PREVENTION I.AUDIBLE&VISUAL ALARMS JM 2.BALL FLOAT ❑3.FILL TL)BP,.5HFJT-0FF VALVE *z.
<br /> ❑4Tg1-VICMEBTS LIIREMSNTSFOREXIiMo'1TOil�OMOVERKII.LPREVSNTYON'EQUIPMENT
<br /> V. 'RODUCT/WAS' E TF'IN CONSTRUCTTON'
<br /> P�rivG CGN5TktSCTION ❑ I.SINGLE WALL Ig 2.DOTMXZ WALL ❑ 99.0THVR 460.
<br /> SYSTEM TYPE F1 I.PRESSURE ❑ 2.GRAV'IT'Y ❑ 3.0 TONAL SUCTION ❑ 4 SA1•M SUCTION I23 CCR{2636(0)(3)1 4%.
<br /> PRIMARY!LDNTAINMENT ® I.STEEL .0`'4 FIBERGLASS ❑ S.FLp,}CMLE ❑ 10.R]GIDPLASTIC
<br /> _ ❑ 90.NONE 11 95-mgl'OWN ❑ 99.OTHER(Spec' 464&
<br /> SECONDARY CONTAINMENT IM 1.SYEEL ® 4 FIBERGLASS ❑ 8_FLV-XLO X f� Io.>tIGID PLA37T0
<br /> ❑90.NONE ❑ 95.t7xx+TOWN ❑ 99M OTHBI2(Sr4c ): 4640.
<br /> PW1Nr_T/T[InWB CONTAINMENT SMTP TYPE 29 1,SINGLE WALL ® 2.DOUBLE WALL - -
<br /> D 90.NONE 4643
<br /> :,n,:,
<br /> C. EVENT)�AP4R REC,.
<br /> OVE (V1 )AND BSER/.FJ%L PIPE PRENIG CONSTRUCTION
<br /> VENT PfiI MRY CONTAINMENT ❑ 1.STVZL ®4 MERGL.ASS 1❑ 10.RIOM PLASTIC ❑ K NONE ❑ 99.OTBE)_>(Specify): Vii.
<br /> VENT SECON-DAR'YCONTAINMENT ❑ 1.STEEL ® 4k7BERGLASS ❑ ]0.R OmkLASTTC ❑90.NONE ❑ 99.OTILER(Specify)=
<br /> VR PRIMAIRY CONTAINMENT 0 L STEEL 0 4.FMER.GLASS ❑ I-,RIGID PL,.ISTTT ❑ 90.NONE ❑ 99,OTHE't(Spacily): gg
<br /> 4 I.
<br /> VR SECONDARY CONTANMENT ❑ I.STH ® 4,FIBERGLASS L3_70-R1GM PI-ZiTIC 0 90.NONE ❑ 99.OTHER(Spedffi);
<br /> 464h1.
<br /> VENT PIPING TRANSITION SUIMP TYPE 0 1.MNGL,E WALL ❑ 2 DOUBLE WALL ❑ 90.NONE 464.
<br /> RISER PRRZ TLE RY CONTAINMENT {! 1.STEEL ❑r;,FIBERGLASS [3 ]O.RIGIDPLASTIC ❑ 90.NONE [] 99.OTW (Specify):
<br /> RISER SECONDARY CONTAINMENT ❑ 1.STmm 0 4.FIl3ERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 9s,OTHER(Spycity):
<br /> PILL COMPONENTS INSTALLED ® 1.SPILL BUC1�T ®3.STRMER PLATE/13OTTQlvi PR)TECTOR f�4.CONTAINMENT X Al ir,N'
<br /> CONSTRUCTION TYPE ® 1-SINGLE
<br /> VTL UNDER DAPENMR�COI�ITAWWNT(UDC)
<br /> 2.DOUBLE WALL ❑ s.NO DISPEVSERS ❑ 90,14am '+W&,
<br /> CONSTRUCTION MATERIAL ❑ I.STEEL ®4.FIBERGLASS ❑ 10.RIGIDPL A STIC ❑ 99.0THER(Specify)
<br /> 469&
<br /> `vim[. CORROSYON PROTECTION .,
<br /> STEEL,COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANOD $} ❑ 4,]MPRES$ED CURRLWT ❑ 6.1SOLATION 448.
<br /> IX. A"IJCANT,LGNATURE
<br /> CMTMCATION,. I cerft that thii'UST systesa is comPstiNe w�floe hffl=dons substance stored and tbm 4m Wer3matim pTovfded Therein is tree,
<br /> ac --A in tY1R cast ce wlkh a! IDES
<br /> APPLICANT3IC3NATURE G: fir, DATE 12/1/2011 470.
<br /> APPLICANT NA'1dE(print) RUSS S MCT+EQ17 471' APPLICAI�T Tff AREA DIRECTOR 472.
<br /> TEG-3 Z10I0Tad EU-1 8L99-EZT-80b sasradi@juH .zood72�-WOHi 9Z:9T TT,-SO-ZT
<br />
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