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IED PROGRAM CONSOLIDATED F UNDERGROUND STORAGE TANK 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) ❑ 1. NEW PERMIT ❑ 3. RENEWAL PERMIT ® 5. CHANGE OF INFORMATION ❑ 6. TEMPORARY UST CLOSURE ❑ T UST PERMANENT CLOSURE ON SITE ❑ R i IST RF.MOVAI. DATE UST PERMANENTLY CLOSED: 430a I 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 SrIE ADDRESS 103 J110 W. TURNER RD. CITY 104 Lodi H. TANK DESCRIPTION TANK ID # 432 605 TANK MANUFACTURER 433 MODERN WLD TANK CONFIGURATION: THIS TANK IS 434 ® 1. A STAND-ALONE TANK ❑ 2. ONE IN A COMPARTMENTED UNIT. Complete one page for each compartment in the unit. DATE UST SYSTEM INSTALLED 435 1/2001 TANK CAPACITY IN GALLONS 436 15000 NUMBER OF COMPARTMENTS IN THE UNIT 437 1 III. TANK USE AND CONTENTS TANK USE ❑ la. MOTOR VEHICLE FUELING ❑ lb. MARINA FUELING ❑ Ic. 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 ❑ lc. MIDGRADE UNLEADED ❑ lb. PREMIUM UNLEADED 440 ® 3. DIESEL ❑ 5. JET FUEL ❑ 6. AVIATION GAS ❑ 8. PETROLEUM BLEND FUEL ❑ 9. OTHER PETROLEUM (Specify): 440a NON -PETROLEUM: ❑ 7. USED OIL ❑ 10. ETHANOL ❑ 11. OTHER NON -PETROLEUM (Specify): 440b IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1. SINGLE WALL ® 2. DOUBLE WALL ❑ 95. UNKNOWN 443 PRIMARY CONTAINMENT ® L STEEL ❑ 3. FIBERGLASS ❑ 6. INTERNAL BLADDER 444 ❑ 7. STEEL+ INTERNAL LINING ❑ 95. UNKNOWN ❑ 99. OTHER (Specify): 444a SECONDARY CONTAINMENT ❑ 1. STEEL N 3. FIBERGLASS ❑ 6. EXTERIOR MEMBRANE LINER ❑ 7. JACKETED 445 ❑ 90. NONE ❑ 95. UNKNOWN ❑ 99. OTHER (Specify): 445a OVERFILL PREVENTION 19 1. AUDIBLE & VISUAL ALARMS 2. BALL FLOAT 19 3. FILL TUBE SHUT-OFF VALVE 452. ❑ 4. TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT / WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ 1. SINGLE -WALLED ® 2. DOUBLE -WALLED ❑ 99. OTHER 460 SYSTEM TYPE ❑ I. PRESSURE ❑ 2. GRAVITY ® 3. CONVENTIONAL SUCTION ❑ 4. SAFE SUCTION [23 CCR §2636(a)(3)] 458 PRIMARY CONTAINMENT ® 1. STEEL ❑ 4. FIBERGLASS ❑ 8. FLEXIBLE ❑ 10. RIGID PLASTIC 464 ❑ 90. NONE ❑ 95. UNKNOWN ❑ 99.OTHER(Specify): 464a SECONDARY CONTAINMENT ❑ 1. STEEL ® 4. FIBERGLASS ❑ 8. FLEXIBLE ❑ 10. RIGID PLASTIC 464b ❑ 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 ) AND RISER /'PILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ 1. STEEL 0 4. FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 90. NONE 99. OTHER (Specify) 464e 464e1 VENT SECONDARY CONTAINMENT ❑ 1. STEEL 0 4. FIBERGLASS ❑ 10. RIGID PLASTIC ® 90. NONE 99.OTHER(OTHER(Specify) SP eci 464f 464£1 VR PRIMARY CONTAINMENT 0 I. STEEL 4. FIBERGLASS ❑ 10. RIGID PLASTIC N 90. NONE 99. OTHER (Specify) 4648 464 1 VR SECONDARY CONTAINMENT 0 1. STEEL ❑ 4. FIBERGLASS ❑ 10. RIGID PLASTIC 0 90. NONE ❑ 99. OTHER (Specify) 464h 464hl VENT PIPING TRANSITION SUMP TYPE 0 1. SINGLE WALL 0 2. DOUBLE WALL 0 90. NONE 4641 RISER PRIMARY CONTAINMENT ® L STEEL 0 4. FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 90. NONE ❑ 99. OTHER (Specify) 464j 464' 1 RISER SECONDARY CONTAINMENT 0 L STEEL ❑ 4. FIBERGLASS ❑ 10. RIGID PLASTIC ® 90. NONE ❑ 99. OTHER (Specify) 464k 464k1 FILL COMPONENTS INSTALLED ® 1. SPILL BUCKET ® 3. STRIKER PLATE/BOTTOM PROTECTOR ® 4. CONTAINMENT SUMP 451a -c VII. UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE ❑ 1. SINGLE WALL ❑ 2. DOUBLE WALL ® 3. NO DISPENSERS ❑ 90. NONE 469a CONSTRUCTION MATERIAL ❑ 1. STEEL ❑ 4. FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 99. OTHER (Specify) 469bc VIII. CORROSION PROTECTION , STEEL COMPONENT PROTECTION ❑ 2. SACRIFICIAL ANODE(S) ❑ 4. IMPRESSED CURRENT ® 6. ISOLATION 448. IX. APPLICANTSIGNATURE CERTIFICATION: I certify that this UST system i compatible with the hazardous substance stored and that the information provided herein is true, accurate, and in full compliance witbAtfaLregWrejVents. APPLICANT SIGNATURE DATE 470. 2/2/2009 APPLICANT NAME (print) 471. Steven J Hall APPLICANT TITLE 472• Manage, EH&S UPCF UST -B - I/1 Rev. (12/2007)