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UNIFIED PROGRAM CONSOA FORM 10 UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION(Ono form per usT) TYPE OF ACTION (Check one item only. For an UST permanent closure or removal,complete only this section and Sections I,If,III,IV,and IX below) 430 ® 1.NEW PERMIT El3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION 6.TEMPORARY UST CLOSURE 7.UST PERMANENT CLOSURE ON SITE Q 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 430a DATB EXISTING UST DISCOVERED: 430b 7-7 FACILITY ID#(Agency Use Only) BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 Walmart' BUSINESS SITE ADDRESS 103 3010 W Grant Line Rd CITY Tracy, CA ' TANK ID# 432 TANK MANUFACTURER 437 TANK CONPKIURAT[ON:THIS TANK IS 434. Containment Solutions [31•ASTAND-ALONE TANK / [12.ONE IN A COMPARTMENTED UNIT. Camulde pop ibreaeh cauMmUrad�ausumh DATE UST SYSTEM INSTAL00 435 %,dK CAPACITY IN GALLONS 436 NUMBER O COMPART NlEIV1 S MTHE UM 437 age aT W A TANK USE 0 1a.MOTOR VEHICLE FUELING" ❑ lb.MARINA FUELING ❑ lc.AVIATION FUELING 439 0 3.CHEMICAL PRODUCT STORAGE ❑4.HAZARDOUS WASTE(Include&Und 0i) ❑5.EMERGENCY GENERATOR P(JEL_[IISC§2528 L5(c)] [36.OTHER GENERATOR FUEL (395.UNKNOWN $I 99.OTHER(sped ): U s e Cl Motor N391 CONTENTS PETROLEUM: ❑ la RBGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ❑ 16 PREMIUM UNLEADED 440 Q ❑3.DIESEL ❑5.JET FUEL ❑6.AVIATION GAS 138.PETROLEUM BLEND FUEL E39.OTHER PETROLEUM S . 440& NON-PETROLEUM:0 7.USED OIL 0 10.ETHANOL 1.OTHER NON-PETROLEUM(Swaary 440b TYPE OFTANK 1.SINGLB WALL 13 Z.DOUBLE WALL E3 95.UNKNOWN 443 PRIMARY CONTAINMENT 1.STEEL 3.FIBERGLASS 6.BVIERNAL BLADDER 444 ❑7. STEEL+INTERNAL LINING ❑95.UNKNOWN ❑99.OTHER S 444, SECONDARY CONTAINMENT 1.STEEL 3.FIBERGLASS 6.EXTERIOR MEMBRANE LINER ❑7.JACKETED 445 ❑90.NONE ❑95.UNKNOWN ❑99.OTHER 445& OVERFILL PREVENTION 1.AUDIBLE&VISUAL ALARMS 2.BALL FLOAT 3.FILL TUBE SHUT OFF VALVE 452 ❑4.TANK MEBT3 REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION BQUIPMENT .. PIPING CONSTRUCTION I.SINGLE-WALLED ❑2.DOUBLE WALLED 9y:OTf1SR 460 SYSTEM TYPE 1.PRESSURE 2.GRAVITY 3.CONVENTIONAL SUCTION 4. E SUCTJON CCR§2 ) ISS PRIMARY CONTAINMENT :0 1.STEEL ❑4.FIBERGLASS 8.FLEXIBLE 10.RIGID PLASTIC ❑90.NONE 0 95.UNKNOWN ❑99.OTHER(Speci : 464& SECONDARY CONTAINMENT ® L STEEL 0 4.FIBERGLASS U 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464b ❑90:NONE ❑95.UNKNOWN ❑".OTHER(S ): 464a PIPINGffURBINB CONTAINMENT SUMP TYPE 0 1..SINGLE WALL ❑2 DOUBLE WALL 90 NONE 4644 VENT PRIMARY CONTAINMENT M 1.STEED 4.FIBERGLASS ❑ 10.RIGID PLASTIC U 90,NONE U 99.OTHER(Spepify) 464e 464al VENT SECONDARY CONTAINMENT 1.STEEL 4.FIBERGLASS 10.RIGID PLASTIC 0.NONE 99.OTHER(Specify) 464f 464fl" VR PRIMARY CONTAINMENT E3 I.STEEL 4.FIBERGLASS 13 !0.RIGID PLASTIC 13 90.NONE 13 99.66-M(Specify) 4648 46491 VR SECONDARY CONTAINMENT 13 1.STEEL U 4 FIBERGLASS 13 10.RIGID PLASTIC 90.NONE 13 99.OTHER(Specify) 46" VENT PIPING TT464h1 AIN SUMP TYPE I.SINGLE WALL 2.DOUBLE WALL 90.NONE 4641 RISER PRIMARYY CONTAINMENT U. 1.STEEL 4.FIBERGLASS Ll 10.RIGID PLASTIC El 90.NONED 99.OTHER(Specify) 4641 RISER SECONDARY CONTAINMENT 0 1.STEM 4.FIBERCrLASS 4641 10.RIGID PLASTJC 90.NONE 99.OTHER"(Spe ify) 464k FH L COMPONENTS INSTALLED 1.SPHb BUCKET 3,sTRwjW PLA M PROTECTOR 4.CONTAINMENT SUMP 4 &c CONSTRUCTION TYPE U 1.SINGLE WALL ❑2 DOUBLE WALL ❑3.NO DISPBNSHRS 90.NONE 469& URW RUCTION MA I.STEM. ❑ 4.FIBBRGLA33 10 RIGID PLASTIC 99.OTHER(3 ) 4696-c STEEL COMPONENT PROTECTION ❑2.SACRHgCIAL ANODB(3) ❑4.DiPRB3SBD CURRENT ❑6.ISOLATION 448. CERTIFICATION:I certify that this UST system is compatible with the hazardous substance stored and that the Ioformat[on previded herein is true,accurate, and in full compliance with legal requirements. SIGNA DATE aw. APPLICANT NAME(pant) 471. AFPLIC�NT TtT�E 472 ovin ton Maass Permit Coordinator, BRR Architectur UPCF UST-B-U2 Rev.(12/2007)