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NEW WEST PETROLEM Fax Aug 13 2009.,10:29am , P006j022___.,_.
<br /> *JNIFIED PROGRAM CONSOLIDATED W- 1 /�,,UNDERGROUND STORAGE TAN /�v ,
<br /> OPERATING PERMIT APPLICATION-TANK UNTORDI ATION(One form per U57')-010 0
<br /> u O r
<br /> TYPE OF ACTION (Check one item only. For an UST permanent closure or removal,complete only this section anew ections 1,11,TTI,1V,and IX below) °30
<br /> ❑ 1.NEW PERMIT ® 3,RENEWAL PERMIT ❑ 5.CH4L VGE OF INFORMATION
<br /> ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ S.US'r_REMOVAL
<br /> DATE UST PERMANENTLY C:LOSF,D: 43O° 1 DATE EXISTING UST DISCOS BRED:
<br /> I. FACILITY INFORINIATION
<br /> FACILITY ID 0(Agency Use Only) -77
<br /> BUSMESS'VAN1E(Same as FACILITY NAME or DBA-Doing.Business AS) 3
<br /> Flag City Shell
<br /> BUSINESS SITE ADDRESS 103 CITY - !od
<br /> 54?7 W.Banr.ei'St. I Lodi _
<br /> II.TANK DESCRIPTION -
<br /> TANK IL)rP 1,A d1z TANK MANUFACTURER d33 TANK CON FI0VKATTON: PHIS TANK 1S 414
<br /> �t( ��"� rrUSco ❑ 1.A STAND-ALONE L N K
<br /> A� U (j T- E 2.QNE IN A COMPAA-1 MEN rr;D UNIT.
<br /> Complete Oae past for 0a0h 4,•e•78,iment is the Wait.
<br /> DATE UST SYSTEM INSTALLED "--` TANK CAPACITY IN GALLONS 436 NUMBER OF COMPA 1,TIv12NT$IN THE UNIT 437
<br /> 996 10,000 2
<br /> III.TANK USE AND CONTENTS
<br /> TANK USE N 1a.MOTOR VEHICLE FUELING ❑ 1b.MARTNA FUELING ❑ Ic.)A IATION FUELING
<br /> ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includesi)sed nip C] 5.EM JRGENCY GENERATOR FVFI.IN$C§=wx-))
<br /> ❑ 6.OTI rER CENERATOR FUEL ❑ 95,UNKNOWN ❑ 99,ol.HER (Specif)-): 43?+
<br /> CONTENTS PETROLEUM: ❑ Ia.REGULAR IiNLEADED ❑ 1c.MIDGRADE ONLFADFD ❑ 1 b.IF!EMTL'M UNLEADED 140
<br /> E 3.DIE5F,.L ❑ 5.JET FUY_L ❑ 6.A'':ATION CAS
<br /> ❑ 8.PPTROLEUM BLEND FUEL ❑ 9.OTTER PETROLEUM 5 cif'v: sa7a
<br /> NON-PETROLEUM:❑ 7,USED OIL ❑ 10.ETHANOL
<br /> Q 1f.OTI IER NON-PETROLEU10(52ccif)): 44{,b
<br /> IV. TANK CONSTRUCTION _
<br /> TYPF,OF TANK ❑ J.SINGLE:WALL ® 2•DOUBLE WALL ❑ 95.VNKNONVN 44!
<br /> PRIMARY CONTAINMENT E L STEEL C3-3.FIBERGLASS ❑ C INTERNAL,BLADDER Y 444
<br /> ❑ 7.STEEL-INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTFFEI( ($pecify): 444a
<br /> SE-CONDARY C70NTAI;NM.E;NT ❑ 1,STFEL E 3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER 7.)ACKETED 445
<br /> ❑ 9o.NONE ❑ 95.UNKNOWN ❑99.OTHER(Spcci•): 443a
<br /> OVERFILL PREVENTION ® 1.AUDIBLE 3c VISUAL ALARMS 2.BALL FLOAT ❑ 3.PILL TL f!E 511UT,OFF VALVE 452
<br /> ❑ 4.TANK MFFTS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTC`I EQUiPMENT
<br /> j V. PRODUCT/WASTE PIPING CONSTRUCTION
<br /> I NPING CONSTRUCTION ❑ 1.SINGLE-W.ALLFD ®2.DOUBLE-WALLED ❑99.OTHER 460
<br /> S1'STE✓E TYPE ® 1.PRFSSL%RE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL 51,C:TION I_.I 4.SAFE SUCTION(23 CCR 62E5h(a)(3)) 4°8
<br /> PRIMARY CONTAINI�CrNT ❑ 1.STEEL ® 4.FIBERGLASS ❑ S.FLEXIBLE 1:1 10,RIGID PLASTIC 44d
<br /> Cl 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 404a
<br /> SECONDARY CONTAINMENT ❑ 1,STEEL ® 4.FIRPRGLASS ❑ S.F1,F:XIBLE (_) )0.RIGIP PLASTIC 463b
<br /> i
<br /> ❑ 90.NONE, Q 95,UNKNOWN ❑ 99.QTN5R(Specify): =f 4s
<br /> 1'IP1NG%rURE3INE CONTAINMENT SUMP TYPE ® 1.$1NGLs WALL El 2,DOUBLE WALL (=; 90.NONE 4c40
<br /> V-1.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE 1PIPINC CONSTRUCTION
<br /> VENT PRIMARY CONTAMENT ❑ I.STEEL 0 4.F113U.PGLASS ❑ 10.RIGID PLASTIC ❑ 90-P'NE Lj 99.OTHER(Specif;) 464e
<br /> VENT 5ECOND.ARY C'ONTAINNIENT I.STFF.1. ® 4.FIBERGLASS 10.RIGID PLASTIC 90.TIT.N•E ❑ 99,OTHER(Specify) 1Ni
<br /> ,, 4a4r,
<br /> VK FItIMAR\'CQNTATNMFN'f l I.51-FRL ® 4.FIBER(ILASS 13I0.RIGID PLASTIC C396, n:;NE 99.QTHER(SpcGif':) 4.ax
<br /> I 4Nµ1
<br /> { VR SECONDARY CON7.A!NNIENT 1.5TI F,L 3 4.FIBERGLASS ❑ 10.RIGID PLASTIC Q 90.?b:NF ❑ 99.O'fHEK(Specify) lr•le
<br /> { Wn41A
<br /> VF:N'I'PIPING TRANSITiON'SUMP TYPE �l I.SINGLE WALL ❑ 2.DOUB1,r:WALL ❑ 90.n:NF 4t4i
<br /> 1tT FR T'RLA!ARY CONTnINM-NT �❑ I.STFI L ® 4.FIBERGLASS ❑ 1u.IUGID PLASTIC ❑ 00.1:C NE ❑ 99.OTHER(Specify) 1(4J
<br /> KISER SEC CNDARY(,ONTAINM@NT - I.% EEL FIBERGLAS$ 10.RIGID PLASTIC ❑ 90.`r:N--F'C 99.575m<(Speen:) 4(-k
<br /> _
<br /> I FILL C OMPON?%NTS INSTALLED ).SPILL BUCKET Z 3.STRIKER PLATk%BOTTOM PROTECI'Ult Z •I C'ON AINMENT SL;M:> 451a c
<br /> 'V&Ulf-DER)DISPENSER CONTAINMENT(UDC)
<br /> ('(1\5;'RIiC',-IGN Tti PE fT-j 1.SINGLE WALL ❑ 2.DOLiAI-E`VALL ❑ 3.N}DISPENSERS O 90.NONE. =^++
<br /> 7 QN57RL V(VON.MATERIAL. i.51'J F:1. ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC: ❑ 99.tY114 R(Specify)
<br /> VII). CORROSION PROTECTION
<br /> aE(.C('?atPC)NFNTPROTtiC..T.Q� ❑ 2 SACRU-'ICIAL.ANODY.8S C1 4.1h1PRIiSSLDCURRF,7T _ D. 0.1S()LATIQN
<br /> IX. APPLICANT SIGNATURE
<br /> CERTIFICATION; I certify that this CST syAcm is compatibie with the hazardous substance stored and that tiu information provided herein is true.accu:atc,
<br /> and in full compliancc with Ic al re uiremestt-•
<br /> APPi_IC';1NI SICiN,AT'l1Rt' /,s 1 � .� DATE 6/3 /09 '''
<br /> I
<br /> APPI.ICANT NAME(print) Bob Lackner 47 APPLICANT TIT1,E, Contr-iller
<br /> I
<br /> UPCF UST-H-H7, Rev.(12!2007)
<br />
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