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NEW WEST PETROLEM Fax _ Aug 13 2009 10;29am POOM22,_.....,._�, IIKJNUIED PROGRAM CONSOLIDATED UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORNt kTION(one fom, per uST) - TYPE OF ACTION (Check one item only Foran UST permanent closure Or removal,complete only this section and c motions 1,11,11I,IV,and IX below) 4i0 (� L NEW PER_CT ® 3.RENEWAL VIE ❑ 5.CHaU IGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ S.U51_ZEMOVAL 1 DATE UST PERNIANENTLY CLOSED: "" c DATE EXISTING L:ST DISCO'PRED: 470b I. (FACILITY NI'ORNIATION kF-AC-IL-ITYID-,(Agency Clse 0:11),) ' L j 6 BUSINESS NAME(Same a5 FACIIrTY NANIE or DBA-Doing BusinAs) ) : ess . Flag City Shell _ BUSINESS SITE ADDRESS 103 CITY 104 , 6437 W.Banner St. Lodi _ II.TANK DESCRIPTION _ TANK ID# IB 7� 431 TANK MANUFACTURCR 933 TANK CONFIGURATION CHIS TANK IS 474 11 Trusco �]1.A 5rAKD-ALONE NK n (1 �s r"4'� ! ®2.ONE iN A COMPPJ.7 RENTED UN17. /Z U IJIJ l� Co lao one o for oeob ut n!uvtmmn in ft vni:. DATE-U5T SYSTEM INSTALLED 439 TANK CAPACITY IN GALLONS 436 NUMEIF,R OF C'OMP)6 -MENTS iN THE UNIT as7 996 1 U,000 2 XII.TANK USE AIND CON'Z'ENTS TANK I.SE Z 1a.MOTOR VEHICLE FUELING ❑ ib,MARINA FUELING ❑ It.P. IATIO?s FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Inclu4ea 0ed Qi1) ❑ 5.11d:SRGEA'CY GENERATOR FUEL('SC§125261.NQ) ❑ 15.OTI•IFR GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.C+7 HER (SiJecify): 43°0. C'ON1-ENTS PF..TROLFUNI: ❑ )a•REGUT,AIt UNLF_4DFD ❑ lc.MIDCRADE UNLEADED 10 Ib.FT;'cMIUM UNLEADED a4o ❑ 3.DIESEL ❑ 5.JET FUEL 0 5.A'+'ATION GAS ❑ S.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM (Specify): adoa J� NUN-PETROLEL;M:❑ 7.USED OiL n !0.FTMAN01_ ❑ I1.OTHER:,ON,PET1tQLEUM(Specify): 44pb IV. TANK CONSTRUCTION I 'TYPE OF TANK i•SINGLE WALL ® 2.DOUBLE WALL El 95.UNKNOWN _ 443 PRIMARY CONTAINMENT ® I.STEEL ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444 ❑ 7.STEEL+INTERNAL L1N1NG Cl 95.UN XNUWN ❑ 99.OTHEI: (Speoirv): 4440 SECOND,°RY CONTAINiVIrNT ❑ 1.STEEL 19 3.FIBERGLASS ❑ C EXTERIOR MEMBRANE LINEK ❑ 7.JACKETED 445 ❑ 90,NONE ❑ 95•UNiKNOWN ❑99.OTHER(Specify}: 44`a OVERFILL PREVENTION ® 1.AUDIBLE&VISUAL ALARMS ❑ 2.BALL FLOAT ❑ 3.FILL Tl' F SHIT-OFF'v'ALVE 25 1. C3 A.TANK MEETS REQUiREV1ENT5 POR EXF..MPTION FROM OVERFILL PREL'ENT('N EQl''1PMENT V. PRODUCT/WASTE PIPING CONSTRUCTION i?!PING CONSTRUCTION ❑I.SINGLE-WALLED ®2.DOUBLE-WALLED ❑99,OTHER c6o I SYSTEM TYPE ® I.PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION I' 4.S SL'C T iON I*CCR 1263o(a .lt c+_s NRIMARY CONTAINMTN-T ❑ 1.STEEL ® 4.PIRFRGLASS 0 S.FLEXIBLE 1- to.RIGID PLASTIC 45` ❑ 90.NON- ❑ 95.UNKNOWN ❑ 99.OTHER(Specifv): SEC.0N0 AJRY COIN,TAINMENT ❑ 1.STEEL 0 4.FIBERGLA55 ❑ b.FLEXIBLE 10•RIG)D PLASTIC -e4b -E] 90.NONE C395.UNKNOWN ❑ 99.OTHER(Specify): 464c PG.TURBINE CONTAINMENT SLUMP TYPE i 9 1.SINGLE VI ALL ❑ 2.DOUBLE WALL � 90•N01P• fwd VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPIP'�I;CONSTRUCTION N!LN'f P)t:M.ARY CONITAINMEKT ❑ I STEEL 4.PIBFR0LA55. 10.RIGiD PLASTIC ❑ 90 )NL �9.OTkER(Specify) 6'k 4pkI SECONDARY C;ONTAJN.'•1)sNT 1.STEEL jo 4.F1T17RGLASS ❑ IU.RIGID PI.ASTI(- ❑ 9o, +')NE ❑ 9').UTI IER(Specify) a4�f awn K?RWARY CONTA:NM£NT ❑ ).STEEL 4.FINLRGI.AS$ ❑ 1(i.RJG1D PLAS•I.1C Lj 141. )Nl: Ej 99.OTHEK(Specify) arras an4k; V1R SECOXD.R)'CONTAINMSI`T I.STEEL_Z4.FIBERGLASS ❑ 10.R.IGiD PLASTIC 90. 0)NG ❑ 99.OTHER(Soetify) ar.41, 4i,4h i FENT PIPING TRANSI'11ON SUMP TYPE ® 1.SINGE WALL ❑ =.DOUBLE WALL 90. NI)NF a64i R(SI;R PRIi'+IARY CONTAINMENT ❑ 1.STEEL IN 4•'rlBIuRGLASS Lj 10.RIGID PLASTIC ❑ 90. N)NE ❑ 99.(,)Tl-IFR(Specify) Z,+1i 3411 RtS�R S'ril'ONJARY C.UNTAJNM�NT 1.Sl-_' L 3 4.PiBERGLASS ❑ 10.RIGID PLASTIC 90. q)NI! ❑ 99.01'HER(Spc0fy) °OAA 46=k1 FILL COr.1P0?`'F QTS ir``S'T.a LED I.SPiu.BU:'KET 3.STRIKEK PLATEi130TTOM PROTF:C Tc)R ^:.;ON'_AIN�4E.NT SJIM P VII.UNDER DISPENSER CONTAINMENT(UDC.) c'0N5'c'RtiC`1]ON TYPE (R I.SINGi.E WALL ❑ 3.DOUBLE WALL ❑ 3.Ni.T ISPENSERs ❑ 9U.NOMI 4611_ MATERIA(• 1.STEELs•flAFK<,LA." ❑ 10.RIGID PLASTIC ❑ 99•;'r�Ht:R(S x:ifv} '°}k,. L VIII, CORROSION PROTECTION sI _(ot•4Po`+ENT m(:TECTION' ❑ 2,SACRIFICIAL ANOUE(S) ❑ 4,1MPRL•55m)CURRENT ❑ tis(»,;;r1o� _w'-? IY_ APPLICAIN T'SIGNATURE CERTIFICATION!ATION! 1 ccrtiflthat this i7ST system is compatible with the hazardous Substance stored and that `1 r information provided herein i�i true_accurate. and in fail compliance with legal r uir(,,meuts- � AI I LICA IRa T SIGNATI ;, DA.rF' 6130/09 APYI v1'NAY1T,(prinl> Bob nkner nPYLICANTTITI.r iontrolier L:YCF IST-l3-l/3 IZe,.(1'^1107)