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NEW WEST PETROLEM Fax Aug-13 2009 10:30am P010/022 �( ."......_,....._ eow n+mnnd�erwrn�nnnn nvr�rn�»m • MINIFIED PROGRAM CONSOLIDA'T'ED M At- UNDERGROUND STORAGE TANK OPERATING PERrVUT APPLICATION-TANK Il\Tk'OR1 I ATION (Cne form per UST) TYPE OF ACTION (Check one item oe)Iy. For an UST permanent closure or removal,complete oily this section an< !ections 1,11,TTI,IV,and IX belo-) I ❑ 1.N'EIV PBRIMIT 'Z 3.RENEWAL PERMIT ❑ 5.C14 4GE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.USTPERMANEN'CLOSURE ON SITE ❑ S.US'r REMOVAL DATE UST PERM 4\ENTLY CLOSED- 43� I (SATE EXi5TING UST DISCO t'3RED: °'c� F FAI. FACILITY INFORMATION C[IjTY ID#(Agency,Use Only) 1 '11 6 t BC;SI'NESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 Flag City Shell BUSINESS SITE ADDRESS 103 C1Ty ^' 6437 W.Sannar St. Lodi _ II.TANK DESCRIPT)ON TANK ID# 1 B 472 TANK MANUFACTURER 433 TANK CONFIGURATION THIS TANK IS 434 Tru5C0 [Z 1.A STAND-ALONE I..NK G`z 6 v ❑2.ONE IN A COMPAItII.mEN,rF.D UNIT• Comloc m7c2jgLtT each o rr 2amuern in me Anil, DA;C UST SYSTEMINS7,1["I.FD 4?5 TANK CAPACITY IN GALLONS 436 NUMBER OF C'OMPA:kTMENTS IN T142 UNIT 437 1996 30"000 1 III.TANK USE AND CONTENTS _ TANK USE 9 t a.MOTOR VEHICLE FUF•t.ENG ❑ 1b.MARINA FVFLING ❑ tc.!. iAT10'\,vUELTNG 430 ❑ 3.C liVOICAL PRODUCT STORAQZ! ❑ 4.HAZARDOUS WASTE(lnc[uCks L'st4 oil) ❑ 5.Bit iRGENCY(3ENFRATOR FUEL(ksc J25_81 51c)) ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.01 TIER (Specify): 42-04 CC}NTENTS PETROLEUM: Q( )a.REGULAR 1,.Nl,FADED 0 )c.MIDGRADt VNLEADl;D (] 1b,I I:EMIUM UN1.E41.)ED 440 ❑ 3.DIESEL ❑ 5.JET FrUEL ❑ 6.A'a;.aTION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM (Sp ify): 449a VON-PF•TROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON.PETROLEUN•1 S ci : "r-0 IV. TANK CONSTRUCTION TYPE OF TANK ❑ I.5INGLE WALL 13 2.DOUBLE WALL ❑ 95.UtT.NOWN 443 PRL',IARY CONTAINMENT 1.STEEL ❑ 3.FLL3FRGi-.SSS ❑ 6,INTERNAL BLADDER 444 d 7.STEEL-1NTF,RNAL LINING ❑ 95.UNKNOWN ❑ 99.OTIIEK (5peeify): A444 SECONDARY CONTAINMENT C3 t.STEEL ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER" ❑ 7.JACKETED A43 ❑ 90.NONE ❑ 95.L-'NKINOW-N ❑99,OTHER(Specify): 4452 OVERFILL PREVENTION ® 1.AUDIBLE&VISUAL ALARMS 0 2.BALL FLOAT ❑ 3.PILI_TL E Z SHUT-OFF VALVE e5+ ❑ 4.TANK AMZ;TS REQUIREMLNTS FOR EXEMPTI()N FROM OVERFILL PREVENT C N EQUIPMENT _ V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑1.SINGLE-WALLED 0 Z.DOUBLE-WALLED ❑99.OTHER y 460 SYSTEM TYPE 0 1.PRESSURE . ❑ 2.GR4yrrY ❑ 3.CON'VEN770NAL SUCTION ( 1 4.SAFE SUC710N[23 CCR 37036(x)(311 453 PRIMARY CONTAINMENT Q I.STEEL ® s.FIBERGL'•55 ❑ S.FLEXIBLE (] 10.RIGID PLASTIC 464 ❑ 90.NONE ❑ 95•UNKNOWN ❑ 99.OTHER(Specify): 4642 SLCONDARY CONTAINMENT tMTFEL 13 4.FIBERGLASS 0 S.1-LEXIBLE (] 10.RIGID PLASTIC A6-b I ❑ 90.NONE ❑ 95.(NKNOWN ❑ 99"OTHER(Specify): 464[ PIPING%TURBINE CONTAINMENT SUMP TYPE ® 1.SINGLE WALL ❑ 2.DOUBLE WALL I..I 90•NONE VI.VENT,VAPOR RECOVERY(VR)AND RISER/FULL PIPE PIPIN(';CONSTRUCTION VENT PRIMARY C'ONTAIN.tHNT 1•STEEL ® 4,FIBERGLASS C310.RIGID PLASM: 90.rY.-NE C199.OTHER(Specify) _ 454ci V ENT SECONDARY C0t ITAINNIFNT Q 1,STF.F.I, 4.FILiEROLA$$ 10.RIGID PLASTIC ❑ 90.t1C NE-7 99.OTHER(Specify) 4h4f 463;1 VR PRIMARY CONTAIN-ME'NT 1.5Tr;L•L 4.FII3ERGL.4SS ] (().RIGID PLAST[C 90.>!T:NE [j09.OTHER(Specify) say-i VR SECONDARY CONI"AINNIFNT ❑ t.STEFL X 4.FIBERGLASS C7 10.RIGID PLASTIC CD40.'i,NIi11 99.OTHER(Specify) 464h .601 NEN'{'PIPING"fRANSfi SUN 5UNiP'1'YPEI.S1 NG 1,E WALL ❑ 2.DOUBLE.WALL 9L`.CJ;;NE RTSBR PRIMARY CONT.ATNN(ENT ❑ 1.STEEL IN 4.FIBERGLASS W.RIGID PLASTIC ❑ 90.rK NE 9D.OT {=R(Spec fy) 4447 a6Ai 1 MSER SECONDARY CONTi1IN.IcN'1' ❑ I.S':'Ei 4.FIBERGLASS El 10.RIGIp ELASTIC NE 90.O'.'I{ER(Specify) =wc a6cwi ILL.COMPONENTS INSTALI.ED A 1.SKILL BUCKET 9 3.STRJICER PLATWBOTTOM PROTECTOR [5 ('ONTAIN\4rN,'r SUMP :314-c VII.UNDER DISPENSER CONTAINMENT(UDC) C'ONSTR;1('{'ION TYPH m I.SINGLE WAU, D 2.DOUBLE WALL- ❑ 3.N,i DISPENSERS Cr' 9U.NONE C"ONSTR:1CT1UN.ViATTtRI\I; (� 1 5 ri:E). ❑ 4.FIBERGLASS ❑ 1:.RIGID PLASTIC :1 99.0 i 1IF.R 1Spec if\) A6"� VIII. CORROSION PROTECTION ( ST E'r'I.C'ON;'O\F:�'r F'tOT ('PION ❑ 2.SACAla'IC'IAL•ANODE(S) ❑ 4.v,4rRESSL-U C.!;RRF;NT ❑ 6 ISOLATi G:^ 2-"F 1X_ APPLICANT SIGNATURE ,. CERTIFICATION; I certifc that this!)ST system is eompatibiu with the har,rdovs substance stored and that 1h inforination provided herein is true.accurate, and in Cull corn lianca Kith ie-al requirements. _ APPUCANT S)GNATUR r ,1 j -' DATE Al'PL1C.AtN"I" NAME(print;) Bob Lackner 2-7' APPLICANT TITLE Contra;Tier a" UPCF UST-3-112 RCN'.(12/2007)