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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TAINK OPERATING PERMIT APPLICATION - TANK INFORMATION (One form per UST) TYPE OF ACTION (Check one item only. For an UST permanent closure or removal, complete only this section and Sections I, II, III, 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: 430- 1 DATE EXISTING UST DISCOVERED: 430b I. FACILITY INFORMATION FACILITY ID # (Agency Use Only) _ I BUSINESS NAME (Same as FACILITY NAME or DBA-Doing Business As) 3 AT&T Corp. UE231 BUSINESS SITE ADDRESS 103 CITY 104 1110 W. TURNER RD. Lodi IL TAM DESCRIPTION TANK ID # 432 TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK IS 434 UE231 0001 MODERN WLD ® 1. A STAND-ALONE TANK ❑ 2. ONE IN A COMPARTMENTED UNrr. . Comolde one Me for ena compartw=t in the unit. DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 1/2001 15000 1 HL TANK CONTVMS TANK USE E3 la. MOTOR VEHICLE FUELING ❑ lb. MARINA FUELING ❑ lc. AVIATION FUELING 439 ❑ 3. CHEMICAL PRODUCT STORAGE ❑ 4. HAZARDOUS WASTE (Ioeluden Used Od) ® 5. EMERGENCY GENERATOR FUEL [HSC §25281.5(c)] ❑ 6. OTHER GENERATOR FUEL ❑ 95. UNKNOWN ❑ 99, OTHER (Specify): 439a CONTENTS PETROLEUM: ❑ la. REGULAR UNLEADED ❑ Ic. MIDGRADE UNLEADED ❑ lb. PREMIUM UNLEADED 440 ® 3. DIESEL ❑ 5. JET FUEL ❑ 6. AVIATION GAS E38. PETROLEUM BLEND FUEL El9.OTHER PETROLEUM(specify):140a NON-PETROLEUM: ❑ 7. USED OIL 0 10. ETHANOL ❑ 11. OTHER NON-PETROLEUM(Specify): -4°b TANK CONSTRUCTION TYPE OF TANK ty 1. SINGLE WALL C1 2. DOUBLE WALL95. UNKNOWN 443 PRIMARY CONTAINMENT IN 1. STEEL ❑ 3. FIBERGLASS 6. INTERNAL BLADDER 444 ❑ 7. STEEL+ INTERNAL LINING ❑ 95. UNKNOWN ❑ 99.OTHERS i e4aa SECONDARY CONTAINMENT 1. STEEL ® 3. FIBERGLASS 6. EXTERIOR MEMBRANE LINER ❑ 7. JACKETED 445 ❑ 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 Y. PROVIUCTIWAUEPIMGCONMUCTION PIPING CONSTRUCTION 1. SINGLE WALLED 2. DOUBL&WALLED 99.OTHER 460 SYSTEM TYPE ❑ 1. PRESSURE ❑ 2. GRAVITY 3. CONVENTIONAL SUCTION ❑ 4. SAFE SUCTION 23 CCR §2636(,)(3))458 PRIMARY CONTAINMENT I. STEEL 4. FIBERGLASS 8. FLEXIBLE ❑ 10. RIGID PLASTIC 46a [390. NONE ❑ 95. UNKNOWN (399.OTHER(S ify): 464a SECONDARY CONTAINMENT 0 1. STEEL is 4. FIBERGLASS 8. FLEXIBLE 0 10. RIGID PLASTIC 4646 ❑ 90. NONE ❑ 95. UNKNOWN ❑ ".OTHER (Specify: 464c PIPINGPTURBINE CONTAINMENT SUMP TYPE 0 1. SINGLE WALL Q 2. DOUBLE WALL 90. NONE 464d "F, Y O ,_ Y, t PIPING CONSTRUMON VENT PRIMARY CONTAINMENT U 1. STEEL 0 4. FIBERGLASS E3 l0. RIGID PLASTIC 90. NONE 0-0. OTHER (Specify) 464c1 VENT SECONDARY CONTAINMENT 1. STEEL 4. FIBERGLASS 0 10. RIGID PLASTIC 0 90. NONE 99. OTHER (Specify) 464f 464fl VR PRIMARY CONTAINMENT 1. STEEL Ll 4. FIBERGLASS C3 10. RIGID PLASTIC IN 90. NONE 0 ".OTHER (Specify) 4648 VR SECONDARY CONTAINMENT 1. STEEL 4. FIBERGLASS ❑ 10. RIGID PLASTIC 19 90. NONE El 99.OTHER (Specify) 464h 464h1 VENT PIPING TRANSITION SUMP TYPE i. SINGLE WALL Q 2. DOUBLE WALL 90. NONE 464L RISER PRIMARY CONTAINMENT 0 1. STEEL U 4. FIBERGLASS Ll 10. RIGID PLASTIC U 90. NONE L3 99. OTHER (Specify) 4641 464iRISER SECONDARY CONTAINMENT ❑ 1. STEEL El 4. FIBERGLASS 10. RIGID PLASTIC ® 90. NONE 0 99. OTHER (Specify) 464k 4641 FILL COMPONENTS INSTALLED 0 1. SPILL BUCKET 0 3. STRIKER PLATE/BoTrom PROTECTOR 4. CONTAINMENT SUMP 451a-c VM UNDER I) S N CO A ENT CONSTRUCTION TYPE ❑ 1. SINGLE WALL ❑ 2. DOUBLE WALL IN 3. NO DISPENSERS ❑ 90. NONE 469a CONSTRUCTION MATERIAL 1. STEEL 4. FIBERGLASS 3 10. RIGID PLASTIC C399.OTHER S i 4696-e tC'T1014 STEEL COMPONENT PROTECTION ❑ 2. SACRIFICIAL ANODE(S) ❑ 4. IMPRESSED CURRENT 10 6. ISOLATION 448• IX APPLICAW SI ,: AT CERTIFICATION: I certify that ibis UST system is compatible with the hazardous substance stored and that the information provided herein is true, accurate, and in full compliance with Ift&1_5e%uirements, APPLICANT SIGNATURE azo. DATE 6/9/2409 APPLICANT NAME (print) 4�1. APPLICANT TITLE 472. Steven J Hall Manager, EH&S UPCF UST -B -1/1 Rev. (12/2007)