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(0/1 'UNWED PROGRAM CONSOLIDA" UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION(one form per UST) TYPE OF ACTION (Check One item only. For an UST per mag closet or relD M4 camplete only tris=flon and Sections I,q III,IV,and IX below) 430 ® I.NEW PERMIT ❑ 3.RENEWAL PERMIT ❑ S.CHANGE OF 116ORMATION 6.TEMPORARY UST CLOSURE Q 7_UST PERMANENT CLOSURE ON SITE 0 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 430a DATE EXISTING UST DISCOVERED FACH lTY ID#(Agency Uat011 BUSINESS NAME(Sam as FACII.Pi'Y NAME or DBA-Doing Business As) Walmart' BUSINESS SITE ADDRESS `m CT1Y Trac CA 1 3010 W Grant Line Rd Y� TANK ID# 432 TANK MANUFACTURER + TANK CONFIGURATION:THIS TANKL4 Containment Solutions El I.A STAND-ALONE TANK ® f Q 2.ON61NA COMPARTMENTED UNIT. et4 Rree� in ffieumSt DA INSTALLED, 435 TWCAPAC 1NGALLONS 436 NUMBEROPCOMPARTMENTSINTHEUNIT 437 00 7. TANK USE ❑ la.MOTOR VEHICLE PUBI ❑ 1b.MARINA FUBLING ❑ 1c.AviATRTN FUBLING ❑3.CHEMICAL PRODUCT STORAGE ©4.11AZARDOUSWASTE(toda OLWOS) ❑S.BMHRGENCYGENBRATORF[EE,[ASC¢2�lei�dl. ©6.0THERGENBRATORFUEL 11 95.UNKNOWN 99.OTHER ) New Motor 011394 COMM PB7TtOLEUM: ❑ la REGULAR UNLEADED ❑ to MIDGRADB UNLEADED ❑ib.PREm9m UNLEADED 440 ❑3.DIESEL I]S.IIT PURL ❑6.AVIATION GAS ❑8.PETROLEUM BLEND FUEL ❑9.07HBR PETROLEUM (Specift. 4404 NON-PETROLEUM:13 7.USED OI Q 10.MIIANOL 11.GTHERNON-Ph1ROLBUrwt ) New Motor Oil A90b TYPE OF TAMC i.SINGLE WALL 12 2.DOUBLE WALL 95.UNKNO 4 KB PRIMARY CONTAINMENT Ex 1.STEEL LI 3.FMERGLASS EJ 6.INTERNAL BLADDER 444 7.STEEL+DnBRNALLINIIG 95.UNKNOWN ©99.OTHER 3 4440 SECONDARY CONTAINMENT 1.STEEL 3.FIBERGLASS 6.EXTERIOR RAKE LAYER 7_JACKETTE) 445 90.NONE 43.UNKNOWN 99.OTHBR 4454 OVERFILL PREVENTION 1.AUDIBLE&VISUAL ALARMS 2 BALL FLOAT 3.FILL TUBE SHUT VALVE 452 4.TANK MEETS. FOR MMMF M FROM OVERFILL PREVENTEDN EQUIPMENT :. � . PIPING CONSTRUCTION 1.SINGLE-WALLED 2.DOUBLE-WALLED U 99;OTHER 460 SYSTEMTYPE i.PRESSURE 2.GRAVITY 3.CONVBNIIONAL SUCTION r3 4.SAFE SUCTION p3 CCR 458 PRIMARY CONTAINMENT JZI I.STEM U 4.FIBERGLASS Q&FLEXIBLE Ll 10.RIGID PLASTIC 464 ❑90.NONE ❑95.UNxNOwN ❑99. peel : 4644 SECONDARY CONTAINMENT 0 1.STEEL ErT FIBERGLASS E3&FLBX(BLE 10.RIGID PLASTLC 464b ❑90.NONE ❑95.UNKNOWN ❑99.0THER( ): 4640 PIPING/TURBINE CONTAINMENT SUM�P{yTYPE W 1.SINGLE WALL 2.DOUBLE WALL Q 90.NONE co VENT PRIMARY CONTAI4M ENI a 1.STEEL 0 4.FIBERGLASS Q 1O.RJUMPLASTIC Q 90.NONE 99:OTHER(SpeN(y) 4640 4640! VENT SBCONDARY CONTAI�Vf 1.STB 4.FIBERGLASS 10.RIGIDPLASTIC 90.NONE 99.OTI:IBR(Spwo) i VR PRIMARY CONTAINMENT El I.STEEL 0 4.FIBERGLASS E3 10.RIGID PLASTIC E3 90.NONE 0 99 OTHER(Spec*) 44641 VR 3BCONDARY C AINMENr E31.ST EEL a. LASS 10.RIGID PLASTIC 90.NONE 99.OTHBR(S avy) 464h7 VENTPIPINGTRANSITIONSUMPTYPE 0 1.SINGLE ALL 2.DOUBLE WALL Q 90.NONE 4641 RISER PRIMARY CONTAINMENT Q I.STEEL U 4.FJIMGLASS EJ 10.RIGIDPLASTIC U 90.NONE 13 99 OTHER(Specify) i .1 RISERSECONDARYCONT I.STEEL 13 4.FIBBRGLASS 13 10105PLAMC 90.NONB -13 99.OTHER,(Sp=*) 64k kl MU COMtPONBNTS INSTALLED 1.SPILL BUCKET 3.STRIKER PLA M PROTHMR 4.CONTAfPID NT SUMP 451a e CONSTRUCITMN TYPE Q 1.sfNGLB WALL ❑2.DOUBLE WALL, Q 3.NO DiSPEN3SRS 90.NONE CONSTTW MATERIAL 1.STEEL. 4.FIBERGLASS R 10.RIGID PLASTIC 99.UIMM 469" STEELCOMPONENTPROTECITON ❑2 SACRIFICIAL NODES) (3 4.94PRESSEDCURRENT ❑6.1SOLATION 448. . ;0Y° . CERTIFICATION:I certify that this UST system II compatible with the hazardous substance stored and that the htforastion provided herein Is true,accarate, and in ra com ce with legal ants. AP SIGNA TATE Mjxafu co /,I be)i 7a. APPLICANT NAME(print) alt. APPLICt?NI TSE 474 Covington Maass Permit Coordinator, BRR Architectur UPCF UST•B-1/2 Rev.(12/2007)