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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION(one form per UST) TYPI'OF ACTION (Check one item only. For an UST permanent closure or removal,complete only this section and Sections 1,11,III.IV.and IX belo:v) 431' ❑ 1.NEW PERMIT 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY LIST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE _❑ 8 UST REMOVAL_ _ DATE(_IST PERMANENTLY CLOSED: 430. DATE EXISTING UST DISCOVERED 1. FACILITY INFORMATION FACILITY ID#(Agency Use Only) _ B(JSINF,SS NAME(Same as FACILITY NAME or DBA-Doing Business As) I Valley Pacific Petroleum Cardlock-Charter Way BUSINESS SITE ADDRESS 03 CITY 104 1501 W Charter Way Stockton II:TANK DESCRIPTION 'TANK ID# A F� �V32 TANK MANUFACTURER 433 TANK CONTIGURATION Tms'FANK Is 134 �j CO Lf ®I.A STAND-ALONE TANK 4 Modern Welding ❑ ONE IN A COMPARTMENreD unrr Cam cye one a fer each com tent m the wtit. DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE I(NIT 437 3/98 12,000 III.TANK USE AND CONTENTS 'LANK USF. la.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ Ic.AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes LlodOil) ❑ 5.EMERGENCY GENERATOR FUEL HSC§_'.57,81 y,t ❑ 6.OTHER GENERATOR FUEL. ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): J3�8 CONTENTS PETROLEUM ® la.REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ❑ Ib.PREMIUM UNLEADED i41 ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM (specify) NON-PETROLEUM.❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUMS i 4406 IV. 'TANK CONSTRUCTION TYPE OF TANK ❑ I.SINGLE WALL 2.DOUBLE WALL ❑ 95.UNKNOWN 443 PRIMARY CONTAINMENT Cl I.STEEL ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444 ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99,OTHER (Spe,fy). 444. SECONDARY CONTAINMENT ❑ L STEEL IN 3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER [I 7.JACKETED 415 ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER.(Specify): 44'a OVERFILL PREVENTION � 1.AUDIBLE&VISUAL ALARMS 2.BALL FLOAT 3.FILLTUBE SHUT-OFF VALVE 4i2 ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑1.SINGLE-WALLED C1 2.DOUBLE-WALLED [199.OTHER ?6u SYSTEM TYPE L.PRESSURE ❑ 2.GRAVITY 3.CONVENTIONAL SUCTION ❑ 4,SAFE SUCTION I23 CCR 92636(.x3)) 45N PRIMARY CONTAINMENT 0 1.STEEL. M 4.FIBERGLASS 8.FLEXIBLE ❑ 10.RIGID PLASTIC 45.3 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify) 464. SECONDARY CONTAINMENT ❑ 1.STEEL IM 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 164b ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(S ci ): 464. PIPING/TURBINE CONTAINMENT SUMP TYPE X 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464d VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION - VEN'r PRIMARY CONTAINMENT 1.STEEL 4.FIBERGLASS 0 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464e _ sruol VENT SECONDARY CONTAINMENT L STEEL ❑4.FIBERGLASS 10.RIGID PLASTIC ❑ 90.NONE N 99.OTHER(Specify) 464f VR PRIMARY CONTAINMENT ❑ 1.STEEL N 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ ",OTHER(Specify) 464g _ 1Cr7Y1 VR SECONDARY CONTAI 14MENT 0 1.STEEL ❑ 4.FIBERGLASS Cl 10.RIGID PLASTIC 90.NONE 99.OTHER(Specify) 4411 4.:411 1 VENT PIPING TRANSITION SUMP TYPE 0 1.SINGLE WALL 0 2.DOUBLE WALL 90.NONE _ VA RISER PRIMARY CONTAINMENT JX 1.STEEL Lj 4.FIBERGLASS Lj 10.RIGID PLASTIC ❑ 90.NONE 99.OTHER(Specify) LAi 4(441 RISER SECONDARY CONTAINMENT 1.STEEL 4,FIBERGLASS 10.RIGID PLASTIC 90.NONE 99.OTHER(Specify) 4641 _ 4641,I FILL COMPONENTS INSTALLED 1.SPILL.BUCKET 3.STRIKER PLATE/BOTTOM PROTECTOR 4.CONTAINMENT SUMP 451a, VII.UNDER DISPENSER CONTApl',TENT(UDC) CONSTRUCTION TYPE ® 1.SINGLE WALL ❑ 2.DOABLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469a CONSTRUCTION MA9FRIAL, ® I.STEEL ❑4.FIBERGLASS 0 10.RIGID PLASTIC ❑ 99.OTHER(Speci ) 469b, �r VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ® 6 ISOLATION 44� IX. APPLICANT SIGNATURE CERTIFICATION: 1 certify that this UST system is compatible with the hazardous substance stored and that the information provided herein is true,accurate m and in full compliance with l 1 requirements. 470 APPLICANT SIGNATURE/ - DATE 3/23/09 APPLICANT NAME(print) 471. APPLICANT TITLE CardlockManaManager g 72 Mike Eliason UPCF UST-B-I/2 Rev.(1212007)