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1
<br /> UNIFIED PROGRAM CONSOLIDATED FORM
<br /> UNDERGROUND STORAGE TANK
<br /> OPERATING PERMIT APPLICATION-TANK INFORMATION(one form per UST)
<br /> TYPE:OF ACTIGAI hCC'Cane rn iEeonl}. For an[?ST permanent closure or rernOV7 complete onlyttais section and Sections 1,11,111,IV,and IX below) 4s}
<br /> 1,NEW PERMIT 0 3.RENEWALIIERMT`T` IM5,CHAN61"t)F INFORMATION
<br /> (, i ls`te�F't?ItARY[1ST Ct.fJS�Ftl 7.lsS C Pt;FtMhl�f:i�iT CI.C7:iLRF £), SITE �.[IST REMOVAL
<br /> sash
<br /> DATE LIST`PI ItMANLNTLY CT,C)';T'1), asaa i3I Ta[EXISTT`3Cr USTDISCOVERED:
<br /> 1. FACILITY INFORMATION
<br /> BUSINESS NAME(Same as FACILITY"NAME or DBA-Doing Busies As)
<br /> C Stop#5449
<br /> BUSINESS SITE ADDRESS ansa CI'T'Y k07
<br /> 522 S.Center pkwyStockton
<br /> M
<br /> 11.TANK DESCRIPTION
<br /> 'TANK ILS 717 -TANK MANUFACTURER 439 TANK C'C>:vHGUPATION* THIS TANS,IS 434
<br /> f ASTAND-ALONE TANK
<br /> /IO #TA0505 44 Xerxes 0 2CJRI INA COMPARTMENTED UNIT
<br /> r-M-ane a a rcu each earn anmrn-en she unit
<br /> DKI't'.LIST SYSTEM INSTALLED 495 TANK CAPACITY IN GALLONS 436 NUMF3L'R GI"COMPAR T'MENTS IN THE UNIT 437
<br /> NIA 15,000 t
<br /> 111.TANK USE AND CONTENTS
<br /> TANK USE Ia MOTOR VEHICLE FUELING ® 1 MARINA FUELING ® Ic.AVIATION Fr1IELING ab4
<br /> ® 3.CHEMICAL PRODUCT STORAGE 0 4 f IA7,NR1)C)US WASTE(Inlud"Ustd Oil) C] S.EMERGENCY GENERATT(.R FUEL it3sc 425291 t(c)7
<br /> ( fa.0T TER GENERATOR FUEL C] 95.UNKNOWN ® 99.OTHER (S ify): 439a
<br /> CH-)Nr ENCS PETROLEt IMT 0 1a,RLGULAR UNLEADED D 1c.MIIDGRADE UNLEADI;'T) Ib.PREMIUM UNLEADED U sea
<br /> 0 ;.DIESEL ® 3,JET Furl [3 6,AVIATION GAS 1401.
<br /> F[ PFLRs® .PkTRczEIM BLEND LGFL ❑ 9. rs,r
<br /> NON-PFT"RC)L<EUM:® '.USED 011, 0 10.ET`liANOI.
<br /> 4d
<br /> 0 11.OT HER NON-PETROLEUM(S es i£v}:
<br /> IV. TANK CONSTRUCTION
<br /> TYPE OF"1ANK ® L SINGLE WALL. Ia7 2.DOUBLE WALL, ❑ 9S.UNKNC)WWtt 4.43
<br /> PRIMARY C ONTAINMEN F" [ 1.STELE M 3.FIBERULASS (1 6.INTERNAL BLADDER 444
<br /> ® 7.STH,1,�INTERNAL LINING n 95.UNKNOWN E] 99.[)TITER (Specify) 444A
<br /> I,STEEL Lqj 3.ik32Lf.[{kzIC2 SEw�RFFwFC] 7,JACKETE
<br /> SECONDARY CONTAINMENT 445
<br /> 90,NONE 0 95,UNKNOWN Q 99.OT 4ER(S 'i£ : 445a
<br /> OVFRFILL PR"`zVLNTION T_AUDIBLE&VISUAL ALARMS B 2.BALL KOAT 10 3.HLT TUBE stiurr-)FF VALVE 452
<br /> ® 4.TANK MEETS RFQUiREMENTS FOR EXEMPTION FROM OV'ERHLt.PREVENTION EQUIPMENT
<br /> V. PRODUCT/WASTE PIPING CONSTRUCTION
<br /> PIPING CONSTR7TI1 E I,F
<br /> SINC ;-WALLEL7 2_F)QLTI3L1=-WALLEI) U 99 OTHER 4
<br /> 60
<br /> SYSTLMI TYPE [ I.PRESS5F Lj 2"GRAVITY ❑ 3.CONVENTIONAL SUCTION 0 4.SAFE,SUCTION J21 CCR§26,a6(43)I 43s
<br /> PRIMA
<br /> RY CONT:AINM4tsa"d"1` ® k,STET L N 4.FIBERGLASS ASS ® S.FLEXIBLE L 10 RIGIDPLASTIC 464a
<br /> 0 90,NONE 0 95 UNKNOWN 0 1)O 0114FR(Speo y);
<br /> SUCONDARV(' NTATV%4F'NT ❑ I STEFL N T_F7II ERGrLrASS 0 8,FLEXIBLE ® 10,RICrit)PLASTIC 4
<br /> 0 40 NONE 0 95,UNKNOWN ® <)9.OTHER(Spcity): adau
<br /> PIPING(fURBINE CGI'AINM NT SUMP TYPE 1.SIN.'L�E WALL, CI 2.I:XXY L F WAL..k.. ® )0 NONE 444d
<br /> N
<br /> VI."VENT,VAPOR.RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION
<br /> VENT'PRIMARY CONTAINMENT L STEE L. � Flk3fiRf,LASS [� L9.Ri£iTll PLASTID 9ED,N')'NF �J.CI"P€IEK t±pecil�) 4bte
<br /> 4WcF
<br /> Vf N"I°SL;C CJN€)ART CCkNTAIN s4ENT f.S'T'IT"L .III3t RGI,ASS IU.I'tIGFI)Txf..rAtiTIC 911,NC)NE 99.f7T'IiTR(SPC sify) 464(
<br /> 4641
<br /> VR PRIMARY CONTAINMwr I.S'IL I;€. .FII3I>RdiLR55 L0.KIGTD PI:ASTIC 90.NC7NE 94.C}°I"Hk IZ{Sl city) 464x1
<br /> VR SECONDARY CONTAINMENT I,S`f I=k L d,tiC3E RCrLASS TO.RIGLL)PLAS'T'IC 90,adt3NF.`, #9.£77 fiER(Specify} 464h
<br /> aCi4ht
<br /> VENT PIPING TRANSITION SUMP 7Y,E I SINGLE WALL 2.I3C3I T3LT WALI, 90.ITQISE� 464i,s1
<br /> RISER PRIMARY CONTAINMENT a,STEEL ® 4.FIBERGLASS ® TG.RIGID PLAS )9,OTHER(Specify) 466'9
<br /> RISER SECONDARY CONTAINMENT' I ST EI k, 4.FII3L RGI.ASS 1{b.RTCsf C)PLAS'CTC 403.NC)Nka ® �).C}TtiP:R(Slxcatp'T d64x4K1
<br /> t
<br /> FILL.COMPONENT'S INSTALIF.I} I.5PfL.L I3UCKP.T 3.STRIKER PLATE!!(,)TTGN4 PROTF>C:FGR 4,CONTAINMENT SUMP 45la-c
<br /> Vii.UNDER DISPENSER.CONTAINMENT(UDC)
<br /> CO;,7RIjCTIONIyFf, 1.SINGLL ALL Lj 2,I.XXIBLE,WALL © 3 NO DISPINSIFRS Q 90.NONE kb�a
<br /> CoNS'k'RIIC`T'Tt)4 MATERLAL. 1.S7I:EL } 4.FIBERGLASS j1 Lti.RIGTL)PI,AS`I"IC< 99,CITFIE469h-C
<br /> VIII. CORRtISION PR()TECTIt�N
<br /> 44
<br /> STET:1,CCJMP(�Nk NiE PRGTEG.TIC)N ".SAC'RTt TCIAL ANC)t)fS) Q 4 IMFPRESSt.tkC URRF>N'1' Ei.TSd)t,AT"It7N
<br /> 13,
<br /> IK. PLiCANT SIGNATURE
<br /> C:ERTIF lCA'T ICT11: 1 cea tify that thts I' 7 system is Contpatilate with the hazrdnaas safbstance stared end[last the infcaranatiarn prr}Vded trF rein is[rare,acczrrate,
<br /> and in full com fiance with I-,'r� 4airements.
<br /> 47u.
<br /> APPLICANT"SIGNATURE DA FE
<br /> 471.
<br /> APPLICANT°NAM (priest) 471 APPLICANT,riTI..I
<br /> Allam Faass Compliance
<br /> C t'(F L' 'l'_T - 2 Rev.(12!2007)
<br />
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