Laserfiche WebLink
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. Fora UST closure or removal,complete only this section and Sections 1,11.111.1V,and 1X below) 430 <br /> ® 1.NEW PERMIT ❑ 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION <br /> 6.TEMPORARY UST CLOSURE 0 7.UST PERMANENT CLOSURE ON SITE 0 8.UST REMOVAL <br /> DATE UST PERMANENTLY CLOSED: 430x. 1 DATE EXISTING UST DISCOVERED: 430b <br /> I. FACILITY INFO TION <br /> FACILITY ID k(Agency Use Only) <br /> BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3 <br /> Tracy Blvd Shell 136186 <br /> BUSINESS SITE ADDRESS 103. CITY 104 <br /> 3725 Tracy Blvd Trac <br /> II. TANK DESCRIPTION <br /> TANK ID# 432. TANK MANUFACTURER 433 TANK CONFIGURATION:THIS TANK IS 434. <br /> 1.Aor tub <br /> 4-Diesel Owens Coming ® 2.ONE INNA OMPARTMENTEDUNIT ccompmmen 1)xE TANK convide ow Page f <br /> DATE UST SYSTEM INSTALLED 435. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS IN THE UNIT 437 <br /> 5-22-1990 12,000 <br /> III. TANK USE CONTENTS <br /> TANK USE ® Ia.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ lc.AVIATION FUELING 439 <br /> C13.CHEMICAL PRODUCT STORAGE [34.HAZARDOUS WASTE(1-k-t-U-d aq ❑ 5.EMERGENCY GENERATOR FUEL IHsc§252s1.5(c)) <br /> ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 439a <br /> CONTENTS PETROLEUM: ❑ Ia.REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ❑ Ib.PREMIUM UNLEADED 440. <br /> ® 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS <br /> ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM(Specify): 4401 <br /> NON-PETROLEUM:❑ 7.USED OIL - ❑ 10.ETHANOL <br /> ❑ 11.OTHER NON-PETROLEUMS ): 440b. <br /> IV. TANK CONSTRUCTION <br /> TYPE OF TANK ❑ I.SINGLE WALL ® 2.DOUBLE WALL ❑ 95.UNKNOWN 413 <br /> PRIMARY CONTAINMENT ❑ L STEEL ® 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444. <br /> [3 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ ".OTHER(Specify): 444a. <br /> SECONDARY CONTAINMENT C] L STEEL ®3.FIBERGLASS [36.EXTERIOR MEMBRANE LINER C37.JACKETED 445. <br /> ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specify): 445L <br /> OVERFILL PREVENTION ® 1.AUDIBLE&VISUAL ALARMS ❑ 2.BALL FLOAT ® 3.FILL TUBE SHUT-OFF VALVE 452. <br /> ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT <br /> Vs 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 (3 4.SAFE SUCTION 123 CCR§2636(.X3)) 458. <br /> PRIMARY CONTAINMENT ❑ L STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464. <br /> ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Speci ft. <br /> SECONDARY CONTAINMENT ❑ 1.STEEL ® 4 FIBERGLASS ❑ S.FLEXIBLE ❑ 10.RIGID PLASTIC 4646 <br /> ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 04c _ <br /> PIPINGfrURBINE CONTAINMENT SUMP TYPE ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 4644 <br /> VI. VENT,VAPOR RECOVERY )AND RISER/FILL PIPE PIPING CONSTRUCTION <br /> VENT PRIMARY CONTAINMENT ❑ I.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 9o.NONE ❑ 99.OTHER(Specify): 46Me, <br /> VENT SECONDARY CONTAINMENT [3L STEEL ® 4.FIBERGLASS (310.RIGID PLASTIC [390.NONE ❑ 99.OTHER(Specify): 4644n. <br /> 4649 <br /> VR PRIMARY CONTAINMENT ❑ L STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 46W <br /> VR SECONDARY CONTAINMENT E31.STEEL ® 4.FIBERGLASS [310.RIGID PLASTIC [390.NONE ❑ 99.OTHER(Specify): ae h1 <br /> VENT PIPING TRANSITION SUMP TYPE ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464i <br /> RISER PRIMARY CONTAINMENT ® L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): q j' <br /> RISER SECONDARY CONTAINMENT ❑ L STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 4664k 1. <br /> FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET ® 3.STRIKER PLATEIBOTTOM PROTECTOR ® 4.CONTAINMENT SUMP 451.-e. <br /> VII.. UNDER DISPENSER CONTAINMENT(UDC) <br /> CONSTRUCTION TYPE ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469a. <br /> CONSTRUCTION MATERIAL ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 466%. <br /> VIII. CORROSION PROTECTION <br /> STEEL COMPONENT PROTECTION 2.SACRIFICIAL ANODES ❑ 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 IevA requirements. <br /> ato. <br /> APPLICANT SIGNATURE DATE 7/19/2010 <br /> APPLICANT NAME(print) Fadi Afa Al-Refaee 471 APPLICANT TITLE Agent for Owner 472. <br /> UPCFUST-B Rev.(1212007)-1/2 www.unidomorg <br />