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„ • ,� �' I � � �° -moo S�-o �Sfv � ��a�� . , UPCF UST -B - 1/2 ticv. (12/2007) UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION -TANIC INFORMATION (one form per UST) TYPE OF ACTION (Check one [tem only, Foran US'f permanent closure or removal, complete only this section and Sections I,11, III, IV, and IX below) 430 ® 1. NEW PERMIT ❑ 3. RENEWAL PERMIT' ❑ 5. CHANGE OF INFORMATION ❑ 6. TEMPORARY UST CLOSURE ❑ 7. UST PERMANENT CLOSURE ON S[TE ❑ 8. UST REMOVAL DATE UST PERMANENTLY CLOSED: 43oa DATE EXISTING UST DISCOVERED: 43ob I. FACILITY INFORMATION FACILITY ID # (itgeacy Use O�fly) _ I BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3 7�Eleven, Inc BUSINESS SITE ADDRE�� 103 CITY 5+,.� Stockton l04 1�ey I �� ' II. TANI{DESCRIPTION TANK ID If 472 TANK MANUFACTURER 433 TA ,K CONFIGURATION: THIS TANK IS �1.ASTAND-ALONETANK 434 x�%rlo. /e � ❑ 2. ONE IN A COt,•IPARTMENTED UNIT l/1 / �j l� . Com Icte one a e for each com artmenl in the °nil. DATE UST SYSTEM INSTALLED 435 TA1�C�AtP�ACI�1N GALLONS 43G NUMQER OF COMPARTMENTS IN T[•IG UNIT 43� LL III. TANIC USE AND CONTENTS TANK USE In. MOTOR VEHICLE FUELING ❑ ib. MARINA FUELING ❑ Ic. AVIATION FUELING 434 � 3. CHEMICAL PRODUCT STORAGE ❑ 4. HAZARDOUS \VASTE (Includes Used Oiq ❑ 5, EMERGENCY GENERATOR FUEL [HSC $25281.5(c)) ❑ 6.OTIiER GENERATOR FUEL ❑ 9S. NKNOWN ❑ 99.OTHER (Specify): 434a CONTENTS PETROLEUM: ln. REGULAR UNLEADED ❑ Ic, MIDGRADE UNLEADED ❑ Ib. PREMIUM UNLEADED- ,'� 440 3, DIESEL ❑ 5, JET FUEL ❑ G, AVIATION GAS � i ❑ 8. PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM S �eolf 44on NON -PETROLEUM: ❑ 7. USED OIL ❑ 10. ETHANOL ❑ I I, O•fHER NON -PETROLEUM S �ecif ); 44ob IV. TANIC CONSTRUCTION �, s �`{' '� � � ��, ,, TYPE OF TANK ❑ 1. SINGLE WALL .DOUBLE WALL ❑ 95. UNKNOWN 443 PRIMARY CONTAINMENT ❑ I. STEEL 3. FIDERGLASS ❑ G. INTERNAL BLADDER - , 444 ❑ 7. STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): ,- �-�`�-•l��).��`3-� 444a SECONDARY CON•fAINMENT ❑ 1. STEEL ' f7�3. FIBERGLASS ❑ G, EXTERIOR MEMBRANE LINER ❑ 7. JACKETED'' - � 445 ❑ 90, NONE ❑ 95. UNKNOWN ❑ 99.0'I'HER (S �ecify): '; - t`�--, �(+ � ' "�•� � 445a OVERFILL PREVENTION � I. AUDIBLE &VISUAL ALARMS ❑ 2. DALL FLOAT 3. FILL TUDE 5H.UT-AFF VALVE 452. ❑ 4.'1'ANK MEETS REQUIREMENT'S FOR EXEMPTION PROM OVERFILL PREVEN'f10N EQUIPA4ENT V. PRODUCT /WASTE PIPING CONSTRUCTION • PIPING CONSTRUCTION ❑ I. SINGLE-1VALLED . DOUDLE-WALLED ❑ 99. OTHER 4Go SYSTEM TYPE 1. PRESSURE ❑ 2. GRAVITY ❑ 3. CONVENTIONAL SUCTION ❑ 4, SAFE SUCTION [23 CCR p2G3G(ax))] 458 PRIMARY CONTAINMENT ❑ 1. STEEL '�,4. FIBERGLASS ❑ 8. FLEXIBLE ❑ 10. RIGID PLASTIC 4Ga ❑ 90. NONE ❑ 95. UNKNOWN ❑ 99, OT[-IER(Specify): 4G4a SECONDARY CONTAINMENT ❑ 1. STEEL 4. FIBERGLASS ❑ 8. FLEXIBLE ❑ 10. RIGID PLASTIC 4G4b ❑ 90. NONE ❑ 95. UNKNO\VN ❑ 99.OTHER (Specify): 4G4c PIPINGl1'URD[NEfONTAINMENT SUMP TYPE ❑ I. SINGLE IVALL 2. DOUBLE WALL ❑ 90, NONE 4G4a VI. VENT, VAPOR RECOVERY (VR) AND RISER /FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ I. STEEL 4. FIBERGLASS ❑ 10. I2[GlD PLASTIC ❑ 90. NONE ❑ 99.07'HER (Specify) 4G4e 4G4c1 VENT SECONDARY CONTAINMENT ❑ 1. STEEL 4. FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 90. NONE ❑ 99.OTHER (Specify) 4G4f 4G•Ifi VR PRIMARY CONTAINMENT ❑ I. STEEL 4. FIDERGLASS ❑ 10. RIGID PLASTIC ❑ 90. NONE ❑ 99.OTHER (Speoify) 4G4b 464 I VR SECONDARY CONTAINMCN'C ❑ I, STEEL d. FIDERGLASS ❑ 10, RIGID PLASTIC ❑ 90. NONE ❑ 99.OTHER (Specify) 464h 464h1 VENT PIPING TRANSITION SUMP TYPE ❑ I. SINGLE WALL .DOUBLE WALL ❑ 90. NONE 4G4f• RISER PRIMARY CONTAINMENT 1, S'CEEL 4. FIBERGLASS ❑ 10, RIGID PLASTIC ❑ 90. NONE ❑ 99.OTHER (Specify) 464j 464' I RISER SECONDARY CONTAINMENT ❑ 1. STEEL 4. FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 90. NONE ❑ 99, OTHER (Specify) 4Gak aG41:1 FILL COMPONENTS INSTALLED I. SPILL BUCKET 3. STRIKER PLATE/BOTTOM PROTECTOR 4. CONTAINMENT SUMP 451a•c VII, UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE ❑ I. SINGLE WALL 2. DOUDLE WALL ❑ 3. NO DISPENSERS ❑ 90. NONE 4G4a CONSTRUCTION MATERIAL ❑ I. STEEL .FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 99.OTHER (Specify) 4G96•c VIII. CORROSION PROTECTION STEEL COMPONENT' PROTECTION ❑ 2. SACRIFICIAL ANODES) ❑ 4. IMPRESSED CURRENT G. ISOLATION 448• IX. APPLICANT SIGNATURE CCRTIRICATION: I certify that this UST system is compatible with the ha2ardous substance stored anti that the Information provided herein is h•uc, accurate, and in fill com liancc With Ic al re uirements. APPLICANT SIGNATURE DATE /Co/� G� 4�0. Ol APPLICANT NAME (print) ail' APPLICANT'I'ITLE 472. UPCF UST -B - 1/2 ticv. (12/2007)