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UE231 <br /> UNIFIED PROGRAM CONSOLIDATED FORM SK <br /> UNDERGROUND STORAGE TANK <br /> OPERATING PERMIT APPLICATION-TANK INFORMATION(One form per UST) tN <br /> TYPE OF ACTION (Check one item only. Form UST permanent closure or removal,complete only this section and Sections 1,11,III,IV,and IX below) 430 °\k <br /> ❑ <br /> I.NEW PERMIT ❑ 3.RENEWAL PERMIT ® 5.CHANGE OF INFORMATION <br /> ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL <br /> DATE UST PERMANENTLY CLOSED: 430° 1 DATE EXISTING UST DISCOVERED: mob <br /> I. FACILITY INFORMATION <br /> FACILITY ID#(Agency Use Only) FA C U s/ _ _ 1 <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) /l r1,D O 3 <br /> AT&T Corp. UE231 g [� <br /> BUSINESS SITE ADDRESS 103 1 CITY ^ 104 <br /> 110 WTURNER RD#J Lodi ! ( � QMffl <br /> II.TANK DESCRIPTION O n <br /> TANK ID# 432 TANK MANUFACTURER 433 TANK CONFIGURATION: Ti IIS TANK IS n 434 <br /> UE2331AO06 U Unknown ®1.A STAND-ALONE TANK } e\ <br /> \1 (� O2letecuNE Meform6ro atmnhUlth IMI J <br /> DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS d36 NUMBER OF COMPARTMENTS IN THE UNIT 437 <br /> 1/2000 120 1 <br /> III.TANK USE AND CONTENTS <br /> TANK USE ❑ Is.MOTOR VEHICLE FUELING ❑ 1b.MARINA FUELING ❑ Ic.AVIATION FUELING 439 <br /> ® 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE Imdadc:Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§25261.5R)I <br /> ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER (S ccify): 439° <br /> CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ❑ Ib.PREMNM UNLEADED 440 <br /> ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS <br /> ❑ S.PETROLEUM BLEND FUEL ® 9.OTHER PETROLEUM (S cci ): Lube Oil 440° <br /> NON-PETROLEUM:❑ 7.USED OIL ❑ l0.ETHANOL <br /> ❑ <br /> 11.OTHER NON-PETROLEUM(Specify): 4406 <br /> IV. TANK CONSTRUCTION <br /> TYPE OFTANK ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 95.UNKNOWN 443 <br /> PRIMARY CONTAINMENT 1.STEEL U 3.FIBERGLASS Ll 6.INTERNAL BLADDER 444 <br /> ❑ 7.STEEL+INTERNAL LINING 0 95.UNKNOWN ❑ 99.OTHER (Specify): 444° <br /> SECONDARY CONTAINMENT ❑ L STEEL ❑3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445 <br /> El 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(S ¢city): 4450 <br /> OVERFILL PREVENTION ❑ 1.AUDIBLE&VISUAL ALARMS fl 2.BALL FLOAT ❑ 3.FILL TUBE SHUT-OFF VALVE 452, <br /> ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT <br /> V. PRODUCT/WASTE PIPING CONSTRUCTION <br /> PIPING CONSTRUCTION [11.SINGLE-WALLED [12.DOUBLE-WALLED [199-OTHER 460 <br /> SYSTEM TYPE ❑ }.PRESSURE ❑ 2..GRAVITY ®: 3..CONVENTIONAL SUCTION Q 4.SAFE SUCT10N[23 CCR§2636(.)(3)1 458 <br /> 1 PRIMARY CONTAINMENT M L STEEL Q 4.FIBERGLASS Q S.FLEXIBLE ❑ 10.RIGID PLASTIC 464 <br /> ❑ 90.NONE ❑ 95.uNKNOwN ❑, 99.o ULR(SI, ciuy). 464r <br /> SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC4646 <br /> ® 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 4640 <br /> PIPING✓NRBINE CONTANMENTSUMP TYPE ❑ 1.SINGLE WALL. ❑ 2.DOUBLE WALL 0 90.NONE 464a <br /> VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION <br /> VENT PRIMARY CONTAINMENT U I.STEEL ❑ 4.FIBERGLASS ❑ 110.RIGID PLASTIC ® 90.NONE ❑' 99.OTHER(Specify) 464 <br /> 4641,1 <br /> VENT SECONDARY CONTAINMENT d I.STEEL Q 4-FIBERGLASS ❑ 10.RIGID PLASTIC ® 90'.NONE ❑ 99..OTHER(Specify) 464f <br /> 464f1 <br /> VR PRIMARY CONTAINMENT Q L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specity) 464y <br /> 464 I <br /> VR SECONDARY CONTAINMENT ❑ L STEEL ❑' 4.FIBERGLASS ❑ 10.RIGIDPLASTIC El 90.NONE Q 99'.OTHER(Specify) 4646 <br /> 46461' <br /> VENT PIPING-TRANSITION SUMP TYPE ❑ I.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE. 4641. <br /> RISER PRIMARY CONTAINMENT ❑ L STEEL ❑ 4 FIBERGLASS ❑ 10.RIGID PLASTIC El 90.NONE 1j 99..OTHER(Specify) 4641 <br /> 4641 <br /> RISER SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS 11 10.RIGID PLASTIC ®' 90.NONE [1' 99.OTHER(Spceify) 464k <br /> 464kI <br /> FILL COMPONENTS'INSTALLED El.SPILL BUCKET Q3..STRIKER PCATFJBOTI'OM PROTECTOR ❑'. 4..CONTAINMENT SUMP 451ac <br /> VII.UNDER DISPENSER CONTAINMENT(UDC) <br /> CONSTRUCTION TYPE Q I.SINGLE WALL ❑ 2.DOUBLE WALL M 3.NO DISPENSERS ❑ 90.NONE 46% <br /> CONSTRUCTION MATERIAL ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑99.OTHER(S c6fy) 4691*° <br /> VIII. CORROSION PROTECTION �q� <br /> STEEL COMPONENT PROTECTION Q, 2..SACRIFICIAL ANODEQS) ❑'14'.IMPRESSED CURRENT CR 6.ISOLATION ai9, <br /> IX_ APPLICANT'SIGNATURE <br /> CERTIFICATION:.I certify that this UST system f ompatible with the hazardoussubstancestored and.that the information provided heref t is true,accurate,. <br /> and in full cam fiance with re uir <br /> APPLICANT SIGNATURE DATE 470 <br /> 5/22/2012 <br /> APPLICANT NAME(prim) 471, APPLICANT TITLE a '! a 47z <br /> Steven J Hall' Manager, EH8(S,• ;s <br /> kw IE , ;nz,+gin' n� fI(� <br /> UPCF UST-B ,.. / I C ` k,L 12U"- <br /> GI I/I Rev.(12/2007) <br />