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r • •1 UE231 A UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK �y4 OPERATING PERMIT APPLICATION-TANK INFORMATION(One form per UST) ma TYPE OFACTION (Check one item only. For an UST permanent closure or removal,complete only this section and Sections I,H,III,IV,and IX below) 430 ® L NEW PERMIT ❑ 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 430, 1 DATE EXISTING UST DISCOVERED: 4306 L 'FACILITY INFORMATION FACILITY ID#(Agency Use Only) n 1 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) P[^ /7 ZD 3 AT&T Corp. UE231 4 C G BUSINESS SITE ADDRESS 103 CITY 7 104 110 W TURNER RD#I Lodi II.TANK DESCRIPTION G ie-lp TANK H3# 432 TANK MANUFACTURER 433 TANK CONFIGURATION: Ti IIS TANK IS 434 UE231AO07 Unknown ® LA STAND-ALONE TANK T4 a%-105 ❑2.ONE IN A COMPARTMENTED UNIT. Co fete one pagelbr euch coma mcnt in the writ. DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 1/2001 300 1 III.TANK USE AND CONTENTS TANK USE O Ia.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING 0 Ic.AVIATION FUELING 439 0 3.CHEMICAL PRODUCT STORAGE ❑'4.HAZARDOUS WASTE(Includesused oil) 0 5.EMERGENCY GENERATOR FUEL[HSC§2528L5(,)] 0 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN 0 99-OTHER (Specify): 434" CONTENTS PETROLEUM: ❑ Ia.REGULAR UNLEADED 0 Ic.MIDGRADE UNLEADED 0 lb-PREMIUM UNLEADED 4W- 9 3.DIESEL 0 5.JET FUEL ❑ 6.AVIATION GAS 0 8.PETROLEUM BLEND FUEL 0 9.OTHER PETROLEUM (Specify): 440. NON-PETROLEUM:0 7.USED OIL 0 10.ETHANOL ❑ 11-OTHER NON-PEFROLEUM(S city): 4406 IV. TANK CONSTRUCTION TYPEOFTANK I.SINGLE WALL 0 2.DOUBLE WALL 095.UNKNOWN 443 PRIMARY CONTAINMENT 1.STEEL 0 3.FIBERGLASS 0 6.INTERNAL BLADDER 444 0 7.STEEL+INTERNAL LINING 0 95.UNKNOWN 0 99.OTHER (5 ccify): 443n SECONDARY CONTAINMENT 0 L STEEL ❑3.FIBERGLASS 0 6.EXTERIOR MEMBRANE LINER 0 7.JACKETED 445 0 90.NONE 0 95.UNKNOWN 099-OTHER(Specify): 445. OVERFILL PREVENTION 0 1.AUDIBLE&VISUAL ALARMS 0 2.BALL FLOAT 0 3.FILL TUBE SHUT-OFF VALVE 452. 0 4-TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION 01.SINGLE-WALLED 02.DOUBLE-WALLED 099.OTHER 460 SYSTEM TYPE C LPRESSURE 0 2-GRAVITY 0 3.CONVENTIONAL SUCTION 04.SAFE SUCTION[23 CCR§26361n$3)I 45s PRIMARY CONTAINMENT 0 I.STEEL 0 4.FIBERGLASS 08.FLEXIBLE 0 10.RIGID PLASTIC 464 ❑ 9(L NONE 0 95.UNKNOWN 099.OTIHR(Spcclfy): 464 SECONDARY CONTAINMENT ❑ LSTEEL 04.FIBERGLASS 0. 8.FLEXIBLE ❑ 10.RIGID PLASTIC 4646 Ig 90-NONE 0 95.UNKNOWN 0 99.OTHER(Spccify): 464, PIPINGITURBINE CONTAINMENTSUMP TYPE 01.SINGLE WALL 02.DOUBLE WALL CK 90.NONE 464d VI.VENT,VAPOR RECOVERY(VR)AND RISER/'FILL.PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT Eg L STEEL 0 4.FIBERGLASS 0' 10 RIGID PLASTIC 0 90,NONE 0 99.OTHER(Specify) 464, 464e/. VENT SECONDARY CONTAINMENT 0 L STEEL ❑ 4.FIBERGLASS 0 10'.RIGID PLASTIC ®' 901 NONE 0. 94..OTHER(Specify) 464E 464E VR PRIMARY CONTAINMENT 0' [.STEEL ❑ 4.FIBERGLASS 0 10.RIGID PLASTIC 0 90 NONE ❑ 99.OTHER(Specify) 464p 46 I VR SECONDARY CONTAINMENT ❑ I.STEEL ❑ 4 FIBERGLASS 0 10.RIGID PLASTIC 0 90,NONE ❑ 99.OTHER(Spccify) 46411 4MI,,1 VENT PIPING TRANSITION.SUMP'TYPE 0' 1.SINGLE WALL 0' ?DOUBLE WALL 0 90 NONE 464i. RISER PRIMARYQONTA LAMENT ❑ 1.STEEL 0 4.FIBERGLASS 0 10.RIGID PLASTIC 29 90'.NONE 0 99.OTHER(Specify) 4641 464 RISER SECONDARYCONTAINMENT ❑ I.STEEL 0 4 FIBERGLASS' 0. 10.RIGID PLASTIC ®' 90.NONE ❑ 99:.OTHER(Specify). 464k. 464kL FILL COMPONENTS INSTALLED O I.SPILLBL'CKET 03.STRIKER PLATE/BOTTOM PROTECTOR 04.CONTAINMENT SUMP 451.u.c VII.UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE 0 L SINGLE WALL 0, 2.DOUBLE WALL 0 3,NO DISPENSERS 0' 90.NONE 4694' CONSTRUCTION MATERIAL 0 LSTEEL 0 4.FIBERGLASS 0 W.RIGID:PLASTIC 0 99,OTHER(Spccify) 469b-c VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION 0 Z.SACRIFICIAL ANODE(S)` 0 4.IMPRESSED'CURRENT 6.ISOLATION 448. IX. APPLICANT SIGNATURE CERTIFICATION`..1 certify that this UST system i Rmpatible with the hazardous substance stored and that the information provided herein is true,accurate,. and in full compliance witliI ' re uir APPLICANT SIGNATURE DATE 420 5/22/2012 APPLICANT NAME(print) 471. APPLICANT TITLE. 67� Steven J Hall Manager, EH&S' mO -' r, "4. UPCF UST-B .JaGa• `� -11211t 1`VI Rev.(12/2007)