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Alk 1-DNIFIE D PROGRAM CONSOLIDATED BO (l�(D f l UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION(one form Dw uST) IrIPEOFACTION. (Clrcck one item only. For eaUST permament closmo or removal,complete only this Tion and Sacdons L,II,III,IV,mW TX below) 430 ® 1.NEW PERMIT ❑ 3.RENEWAL PMtMTT ❑ S.CHANGE OF INFORMATION 6.TEMPORALLY UST CLOSURE 0 7.UST PERMANENT CLOSURE ON SITE 0 8.UST REMOVAL DATE UST PERMANENTLY CLOSF,D: 431a DATE EXISTING UST DISCOVERED FACILITY ID#(Agency Use ly) y, 13USMESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 Walmart' BUSINESS SITE ADDRESS 103 'CITY lea 3010 W Grant Line Rd Tracy, CA .-T TANK ID# 432 TANK MANUFA 03 TAw CONROURAMM THIS TANK IS 434 Containment Solution 0I.ASTAND-ALONSTANK le [32.ONE IN A COMPARTbGWM UNIT. ae rbr DATE UST SYSTEM INSTALLED, 435 14WK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 (7 TANK USE ❑ la.MOTOR VERICLB FUELING ❑ lb.MARINA FUBLLVQ ❑ Ic.AVIATION FUELING 439 ❑3.CHEMICAL PRODUCTSTORAGB ❑4.1 WAS�B(Im Mm Used 09) ❑S.EMERGENCY G$NER&oRFUEL[BSC izslet�cJl. ❑6.OTHBRGENERATORFUEL ❑95.UNffiJOWN $]99.OTHER >: New Motor O1 CONTENTS PETROLEUM: ❑ Ia.RE AMM UNLEADED ❑ 1c MIDG UNLEADED ❑ ib.PREMIUM UNLEADED 44D ❑3.DIESEL ❑S.mr FUJIL ❑6.AVIATION GAS ❑8.PETROLEUM BLEND FUEL ❑9.OTHER PETROLEUM (3yacift. 44ea NON-PETROLEUM:❑7.USED OIL ❑ IO.ETHANOL I1.OTTiFRNONPETROLBUM New Motor Oil ,Rpy Kum TYPETANK L SINGLE WALL Z.DOUK X WALL 95.UNRNO 443 PRIMARY ODNTAINMENT La 1.STEEL U 3.FIBERGLASS ❑6.INTERNAL BLADDER 444 ❑7.STEEL+INTERNAL LINING 95.UN1CNOWN ❑99.OT m S 444a SECONDARY CONTAIIQMENP 1.STEEL 3.FIBERGLASS 6.EXTERIOR RAKE LEVER ❑7.JACKETED 4 B 1. NONE 5.UNKNOWN ❑99.OTHER 44� OVBRFII L PREVENTION 1.AUDOW&VISUAL ALARMS U 2 BALL FLQAT 3.FILL TUBE SHUT-OFF VALVE 45L [34.TANKMEM REQUUWMWM FOR EXEMPTION FROM OVERFILL PREVENTIONBQUnWW .....• >.• .• _, 7:._. FIPRVG C)NMUCTION 1.SINGLE-WAL LFID 2.DOUBLE WALLED 99: SYSTEMI'm ❑ 1.PRESSURE 2 CiRAVtfY 3.CONVBNITONALSUCTIQN 4.3AFESUCTION Cm ' 8 PRIMARY CONTAmmm W 1.STEEL U 4.FIBERGLASS a&FLEXIBLE 13 10.MOID PLASTIC 464 1390.NONE ❑95.UNKNOWN 1399. paI 464m SECONDARY CONTAINMENT 1.STEEL 4.FIDERGLASS &FLEXIBLE i0.RIGID PLASTIC 139D.NONE ❑95.UNKNOWN ❑99.OnI1ER( ); 46b WMGI TURBUVE CONTAINMBNTSUMP TYPE 0 1.SINGLE WALL Q 2.DOUBLE WALL Q 90.NONE VENTPRIMARYCONTAEVMENT U 1.STEEL El 4.FIBERGLASS E3 IO.RIGID PLASTIC Q 90.NONE U 99.OTB8Rftv0Fy) 464c VENTSWONOARY WN-rAMMT 13 ESTEEL 134.FIBERGLASS 13 talumPLASTIC NONE 0 99,OTHER(Spaify) 46kt VR PRIMARY CONTAINkdENT 1.STEEL C3 4.FIBERGLASS Ij 10.RKOIDPLASTIC 13W.NONE 13 99:OTHER(Spairy) 42 VR SECONDARY CONTAINMENT ❑ I.sTEHL 13 A.FIBERGLASS 13 10.RIGID PLASTIC 1390.NONE 13 99.OTHER(Sj a ) 4646 VENT PIPING TRANSITION SUW TYPE 01.3INGLH ALL 2 LE WALL Q 90.NONE 464L RISERPRIMARYCONTARGUM Q 1.STEEL 134.FII3BRGLA38 E3 IO.REGIDPUMC ❑90.NONE El 99,UfHSR(8pec*) 'I RMSECONAARYCONT i.STEEL 4.FIBERQLASS PI 10.RRiIDA c 1390. 13 99OTHER.(Spa) k k1 FILLCOMPONENTSDWALLED LSPILLBUCKET 0 3.STRUM FLA MPROTECTOR U 4.CONTADIMINTSUMP 4Slaa CONSMUCTiONTYPE ❑ 1.SINGLE WALL ❑2.DOUBLE WALL ❑3.NODISPBIVSER.4 94 NONE CONS 1.STEEL. ❑4.FIBERGLASS 10.RIGIDPLASTIC 99.OTHER 4691+a • :.. R�� y�ygKt�fttf� II1�S mom, .. _ , . . STEEL COMPONENT PROTECTION ❑2.SACRIFICIAL ANODE(S) ❑4.QED CURRENT ❑6.ISOLATION 448 CF.RTIINCATION:I certIfy that this UST syat m is eompadble wHh Ute hazy&us suiistaeee skwW and UW the pmvhw Lenin b&a%sse mte, and In taU cm wild lad mquImmmtL APPLICANT SIGNA - � � DATE 62 i APPLICANT NAME(print) 471. ""L r�E 4n o n ton Maass Permit Coordinator, BRR Architectur Chelsea UPCF UST-B-1/2 Rev.(12/2007)