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2u�oy 2�1= UNIFIED PROGRAM CONSOLIDATED FO UNDERGROUND STORAGE TANK IVC [ l OPERATING PERMIT APPLICATION-TANK INFORMATION(One Form per US]) TYPE OF ACTION (Check one item only. For an LIST permanent closure or removal,complete only this section and Sections 1,11,111,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.LIST REMOVAL DATE UST PERMANENTLY CLOSED: 430a I DATE.EXISTING UST DISCOVERED 0n 1. FACILITY INFORMATION FACILITY ID#(Agency Use Only) _ --LL LL-1--i 1 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business AS) 3 Valley Pacific Petroleum Cardlock-Charter Way BUSINESS SITE ADDRESS 103 CITY X04 1501 W Charter WayStockton Il.TANK DESCRIPTION _ y TANK LD# /x ` 432 TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK IS `I;4 v,� J ®1.A STAND-ALONE DANK Modern Welding ❑2,ONE IN A COMPARTMENTED UNIT. Cmpletew.pag.for each com t in the unit. _ LATE US"r SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 435 NUMBER OF COMPARTMENTS LN TFIE UNIT 437 3/98 12,000 I III.TANK USE AND CONTENTS TANK USE Ia.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ Ic.AVIATION FUELING _ 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used 00 ❑ 5.EMERGENCY GENERATOR FUEL,IHSC§25251 5101 ❑ 6.OTI4ER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(S wiv): _ 431a CONTENTS PETROLEUM ❑ la.REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADFD ❑ Ib.PREMIUM UNLEADED 4;1 ® 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIA'T'ION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM (Specify): 440. NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUMS i ;400 IV. TANK CONSTRUCTION 'TYPE OF"TANK ❑ I.SINGLE WALL 2,DOUBLE WALL ❑ 95.UNKNOWN 443 PRIMARY CONTAINMENT ® I.STEEL, ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444 ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER S ci'): 444a SECONDARY CONTAINMENT ❑ L STEEL CS 3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED " , 441 ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHERS if 441a OVERFILL.PREVENTION 1.AUDIBLE&VISUAL ALARMS 2.BALL FLOAT k 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 JN 2.DOUBLE.-WALLED ❑99.OTHER 40) SYSTEM TYPE L PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR§2630.0)] 458 PRIMARY CONTAINMENT ❑ L STEEL M 4.FIBERGLASS ❑ R.FLEXIBLE ❑ 10.RIGID PLAS'T'IC 464 ❑ 90.NONE ❑ 95,UNKNOWN ❑ 99.OTHER(Specity): "V'4a SECONDARY CONTAINMENT ❑ 1.STEEL (2 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 4646 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464C PIPING,TURBINE CONTAINMENT SUMP TYPE L SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 4644 VL VENT*VAP4?R.REGOYERY, ANpItIERIII,L,PIPEPIETWG.CONSTRUCTION VENT PRIMARY CONTAINMENT Lj L STEEL IN 4.FIBERGLASS Lj 10.RIGID PLASTIC 90,NONE U 99.OTHER(Specify) 464. 464.1 VENT SECONDARY CONTAINMENT ❑ L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ® 99.OTHER(Specify) 4"Ar 464fI VR PRIMARY CONTAINMENT ❑ L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC 90.NONE ❑ 99.OTHER(Specify) u,4H 4%+R I VR SECONDARY CONTAINMENT ❑ L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC 90,NONE 99.OTHER(Specify) 464h _ 4(4hl VENT PIPING TRANSITION SUMP TYPE 1.SINGLE WALL 2.DOUBLE WALL 90.NONE _ 4C11. RISER PRIMARY CONTAINMENT IN L STEEL Ll 4.FIBERGLASS ❑ 10.RIGID PLASTIC U 90.NONE ❑ W.OTHER(Spmify) u'4i 4t:L i RISER SECONDARY CONTAINMENT 1.STEEL 0 4.FIBERGLASS 10.RIGID PLASTIC IN 90.NONE 0 99.OTHER(Specify) 4C+4k _ 464k FILL COMPONENTS INSTALLED 1.SPILL BUCKET 3.STRIKER PLATIJBO'TTOM PROTECTOR 4.CONTAINMENT SUNIP 431- VII.UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469a CONSTRUCTION MATERIAL L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHERS i') 4f')b V4 COWSIOK PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ® 6.ISOLATION ;4A IX. APPLICANT SIGNATURE CERTIFICATION: I certify that this UST system is compatible with the hazardous substance stored and that the information provided herein is true,accurate, and in full compliance with legal requirements. ..,7 470 �r+a APPLICANT SIGNATURE / / � DATE 3/23/09 _- APPLICANT NAME(print) 471 APPLICANT TITLE 472 tp Mike Eliason" Cardlock iVlanager sl. 11PCF UST-R-1;'2 Rev.(12/2007) b