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