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"�' (��640�sD PROGRAM CONSOLIDATED FC! (a (( 10/ho UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION(one form per UST) TYPE OF ACTION (Check one item only.For as UST permanent closure or removal,compWa only this section and Sections I,II Til,TV,and IX below) 430 © 1.NEW PIRtMIT ❑ 3.RENEWAL PERMIT ❑ S.CHANGE of INFORMATION 6.TEMPORARY UST CLOSURE 7-UST PERMANENT CLOSURE ON SITE ELS.USTREMOVAL DATE UST PERMANENTLY CLOSED: 430a DATE EXISTING UST DISCOVERED; 430b IIA FAClI ITY 1D#(Agency Use o,4Jy) lAf ,,� a -,, # BUSINESS NAME(Sauna as FACUffY NAME or DBA Doing Business As) 3 Walmart* BUSINESS SITE ADDRESS 103 CITY Trac CA 1 04 10 W Grant Line Rd Y� TANK ID# 432 TANKMANUFA " TANKCOMOURATtON:THISTANXIS 434 Containment Solutions 0 M 1.A STAND-ALONE TANK/ F3 2.ONE IN A COMPARTMENTED UNIT. am Soreach �ausmM. DA UST SYSTEM IIVST ,ss CAPACITY IN GALLONS 4 NUMBER OF COMPARTMENTS IN THE UNIT 7 iso w. ' . TANK USE 0 la.MOTOR VEHICLE FUBLINO "01b.MARINA FUELING (3 la AVMTH)KFUBLING *9 0 3.CHEMICAL PRODUCT STORAGE ❑4.HAZARDOUS WASTE 1ladada Used 08) Q 5.8bIERGENCY NINERATORFUFd.IItSC IZR8lAc)). 0 6.0THER GENERATOR FUEL Q 95.UNKNOWN 'M 99.OTHER : New Mot O r 0119. CONTENTS PETROLEUM: Q la.REGULAR UNLEADED E3 la MIDGRADE UNLEADED Q ib.PRE&GUM UNLEADED 440 Q 3.DIESEL Q S.JET FUEL ❑6.AVIATION GAS Q 8.PETROLEUM BLEND FUEL 0 9-OTHER PETROLEUM 44sa NON-PETROLEUM 7.USED OIL 0 10.ETHANOL 11.OTHER NON-PETROLEUM New Motor oil 440b mere .. . TYPE OF TANK 1.SINGLE WALL 2.DOUBLE WALL Q 9S.UNKNOWN 44B PRIMARY CONTAINMEN 1.STEEL U 3.FIBERGLASS Q 6.INTERNAL BLADDER Q 7.STEEL+IVT8RNALLIVING 11 9S.UNK130WM 99.OTHER 3 444a SECONDARY CONTAINMENT 1.STBffi. 3.FIBERGLASS 6.EXTERIOR MEMBRANE LIVER 7.JACKETED 45- 3 90.NONE Q UNKNOWN 99.OTHER ): 445. OVERFILL PREVENTION L AUDIBLE 3 VISUALALARMS 2 BALL FLOAT 3.FILL TUBE SHUT-OFF VALVE ®4.TAMMBBT3 FOIL EXEMPTION FROM OVERFILLPREVENTION tPl1dE1V7 7. -777 77 PIPINO CONSTRUCTION i.SINGLE-WALLED 2.DOUBLE WALLED OTHER SYSTEMTYPE ;.PRESSURE 2 VTTY 3.ODNVEN17ONAL SUCTION 13 4.SAFE ON P3CCR42636( PRIMARY CONTAINMENT 0 1.STEEL Q 4.FIBERGLASS U 8.FLEXIBLE U 10.RIGID PLASTID Q 90.NONE ❑95.UNKNOWN Q 99.OT ): 464a SECONDARY CONTAII- ENT IM I.mim Q 4.FIBERGLASS U S.FLEXIBLE 10.RIGID PLASTIC 6 Q 90.NONE ❑95.UNKNOWN ❑99.arm(S9edly): 464e Pu%xvTURBEVS CONTAtNMBNT SUMP#T�YyPPE 11..SINGLE WA-gNxvL1L�Y�h 2.DOUBLE WAJ.L r �h�n}13 W-NONE .. .' y.C° X!F 1?_y�lA 4iRv.�P+iN7`E- '. . 'V�W' .t. i�a {ltClCi. UF'41'+c4.3. VENTPREdARY COI4TAAVMSNT 1.STEEL LI 4.FIBERGLASS 10.RIGID PLA ICQ 90.NONE El 99.OTHER(Sp*) 469et VENT 813CONDARY CONTAINMENT 13 1.S 4.FIBERGLASS E3 10.RIGID PLASTIC 13 OIL NONE 13 99.arm(Spw*) r 46411 VR PRIMARY CONTAINMENT E3 L STEEL 0 4.FIBERGLASS E3 10.RIGE3 PLASTIC 0".NONE C3 99.OTHER(Specify) 469$ VR SECONDARY CONTAINMENT 13 1.STEEL 13 4..FIBERGLASS E3 10.RIGIDPLASTIC 13 90.NONE E3 99.OTHER(Specify) 4646 469h1 vma PIPING TRANSITION SUMP TYPE 0 1.SINGLE Q 2.DOUBLE WALL 0 90.NONE 464 R(SERPRIMARYCONTAI HENT Q LSTEEL U 4. GLASS 13 ItRh3IDPLASTIC U 90.NONE 13 99.OTHER(Spc*) 4469 641 RISER SECONDARY CONTAINMENT Y3 1.ME1. C3 4.F18ERQLAS3 E3 10.RIGIDPLAS77C 90.NONE 13 99.OTHER(SpMiY 46*1 FILL COMPONENTS INSTALLED L SPILL BUCKET 3.31 RICEl;PLATFJB011 OM P ECTOR 4.CONTAINMF,Kf SUMP 451ac CONSTRUCTRktTYP$ 1.SINGLE WALL Q 2.DOUBLE WALL ❑3.NO DISPENSERS. 90.NONE C'I'CON MATERIA. 1.STEEL. 4.FIBERGLASS Q 10.RIGID PLASTIC Q 99.MHER 46WO �.�..,yy., �.��J}.�,��yr�� trCt,��4� �yyp,�,�iyw}-��w.�.pi• ._ STSELCOMPONIINTPROTBCTION Q I SACRIFICIAL ANODE(S) . Q 4.IMPRESSED CURRENT Q 6 ISOLATION C,I;RTIFICATTON:I cert*that this UST system Is cpmp h%k with the hazardous subshmee stm+ed m d that the infornlatlon prot4ded hwda is true,accurate, and In fail w with Igual requivements. SIGN DATE aN 471. 472. APPLICANT NAM ) ) ton Maass P m oordinator, BRR Archit,Igea Covingectur UPCF UST B-1/2 Rev.(1212007)