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�► • UE231 UNIFIED PROGRAM CONSOLIDATED FORM VS,� UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION(one form per UST) TYPE OF ACTION (Check one item only. For an UST permanent closure or removal,complete only this section and Sections 1,11,III,IV,and IX below) Oso F1 I.NEW PERMIT [13.RENEWAL PERMIT ® 5.CHANGE OF INFORMATION [16.TEMPORARY UST CLOSURE -❑ 7.UST PERMANENT CLOSURE ON SITE E:18.UST REMOVAL DATE UST PERMANENTLY CLOSED: 030e DATE EXISTMOUST DISCOVERED: 4301, I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) �/ _ _ I BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) (1 ^ O F n%�D h 3 AT&T Cor . UE231 VVI f V BUSINESS SITE ADDRESS 103 CITY AU 110 W TURNER RD#I Lodi II.TANK DESCRIPTION f �I TANK ID# 432 TANK MANUFACTURER 433 TANK CONFIGURATION: TIIIS TANK IS 434 UE231AOOB Unknown Z LA STAND-ALONE TANK �l B ❑2.ONE IN A COMPARTMENTED UNIT. l D Co Tete one page for each coar,siariant in the wit. DA EUS YS EM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS M THE UNIT 437 1/2000 120 1 III.TANK USE AND CONTENTS TANK USE ❑ le.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ 1C.AVIATION FUELING 439 ® 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Ineludee Usad OO) ❑ 5.EMERGENCY GENERATOR FUEL(HSCg2528151c)) ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 439. CONTENTS PETROLEUM: ❑ Ia.REGULAR UNLEADED ❑ to.MIDGRADE UNLEADED ❑ lb.PREMIUM UNLEADED 440 ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ S.PETROLEUM BLEND FUEL 0 9.OTHER PETROLEUM (specify): Lube Oil 04011 NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 4406 IV. TANK CONSTRUCTION TYPEOFTANK ® 1.SINGLE WALL El 2.DOUBLE WALL ❑ 95.UNKNOWN 443 PRIMARY CONTAINMENT ® 1.STEEL ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444 ❑ 7.STEEL,INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER (S eeffy): - 444° SECONDARY CONTAINMENT ❑ L STEEL Q 3.FIBERGLASS Q 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445 ® 90.NONE ❑ 95 UNKNOWN Q 99.OTHER(Spccify): 445. OVERFILL PREVENTION Q 1.AUDIBLE&VISUAL ALARMS ❑ 2.BALLFLOAT ❑ 3.FILL TUBE SHUT-OFF VALVE 451 Q 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT f WASTE PIPING CONSTRUCTION PIPING CONSTRUCT LON ®L SINGLE-WALLED ❑2.DOUBLE-WALLED ❑99.OTHER 460 SYSTEM TYPE ❑ L PRESSURE ❑ 2.GRAVITY ® 3.CONVENTIONAL SUCTION ❑. 4.SAFE SUCTION(D CCR i2636(aXI)j 458. PRIMARY CONTAINMENT ® I.STEEL ❑ 4.FIBERGLASS Q &FLEXIBLE ❑ 10.RIGID PLASTIC 464 ❑ 90.NONE ❑ 95.UNKNOWN 0, 99.OTHER(Spceify): 464+ SECONDARY CONTAINMENT ❑ I.STEEL. ❑ 4.FIBERGLASS El S.FLEXIBLE ❑ 10.RIGID PLASTIC 4646 ® 90.NONE ❑. 95.UNKNOWN ❑ 99..OTHER(Specify): 464` PIPING/TURBINE CONTAINMENTSUMP TYPE ❑. 1.SINGLEWALL Ell 2.DOUBLE WALL 090..NONE 464d VI.VENT,VAPOR RECOVERY(VR)AND RISER 0 FILL.PIPE.PIPING CONSTRUCTION : VENT PRIMARY CONTAINMENT 0LSTEEL ❑' 4.FIBERGLASS ❑ 10'.RIGID PLASTIC N 90.NONE 01 99,OTHER(Specify) 464, 4W I VENT SECONDARY CONTAINMENT ❑. I.STEEL ❑ 4.FIBERGLASS ❑ l0.RIGID PLASTIC 0 90 NONE ❑ 99.,OTHER(Specify) 464f 464IT VR PRIMARY CONTAINMENT ❑ I.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC N 90.NONE ❑99.OTHER(Specify) 4648 464•: VR SECONDARY CONTAINMENT ❑ I.STEEL EI 4.FIBERGLASS EI 10.RIGID PLASTIC ®, 90.NONE ❑,99.OTHER(Specify)'. 464h 464111 VENT PIPING TRANSITION SUMPTYPE ❑ 1.SINGLEWALL (I] 2.DOUBLE WALL 0 90 NONE 464,. RISER PRIMARYCONTAINMENT ❑ I.STEEL QI 4.FIBERGLASS ❑ 10.RIGID PLASTIC M 90.NONE' ❑ 99.OTHER(Specify) 464j: 4641 RISER SECONDARY CONTAINMENT ❑ LSTEEL ❑' 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE Q 99.OTHER(Specify) 464k. 464k1 FILL COMPONENTS INSTALLED ❑' LSPILL BUCKET- ❑ 3..STRIKER PLATEJBOJ'TOM PROTECTOR '] 4.CONTAINMENT SUMP 451z-c' VII.UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE EI 1.SINGLE WAI L Q 2.DOUBLE WALL El 3.NO DISPENSERS' Q 90.NONE. 469a CONSTRUCTION MATERIAL EI L STEEL ❑' 4_FIBERGLASS ❑' 10.RIGID PLASTIC ❑ 99.01-HER(Specify) 4696•c VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION 0 2.SACRIFICIAL ANODE(S) ❑� 4..IMPRESSED CURRENT El 6.ISOLATION 048' IX., APPLICANT SIGNATURE. CERTIFICATION:.I certify that this UST system'" ompatible with the hazardous substance stored:and that the Information provided herein is true,accurate,. and in full compliance with o S re ufr s: oe APPLICANT SIGNATURE DATE 470. 5/22/2012 APPLICANT NAME(print) 471. APPLICANTTITLE 472. Steven J Halt Manager, EH ,- T ' I, UPCF UST-B --7 l V ` Rev.,(12/2007)'