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• � l L..tFIED PROGRAM CONSOLIDATED FO UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION(one form per UST) TYPE OF ACTION (Check one item only. Foran UST permanent closure or removal,complete only this section and Sections 1,11,III,IV,and IX below) ssssssss7mo ❑ 1 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 I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) B ..S ESS NAME Same as FACILITY �or DBA-Doing��nws As) 3 1 `.5 '4 SINESS E SS 6 104 i 11.TANK DESCRIPTION TANK ID# 432 TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK IS 434 `?oaoz3lE TANK y`d5a5D��9 �Y { \� Tru�co �I.ONEIND-ALONARTME JJ�� 11 V t7t-V lug.ONE 7N ACOMPARTMENTED UNIT C.P1 foreun.9m maM1intM1eunit. DATE T SYSTEM INS6LL 43s TANK C P�CIT A S a36 NUMB R OF COMPARTMENTS IN THE UNIT air ODD III.TANK USE AND CONTENTS TANK USE K le.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ lc.AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE g.awm Used Oii) ❑ 5.EMERGENCY GENERATOR FUEL IHSC§252815(c)) ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN Q 99.OTHER (Specify): 43% CONTENTS PETROLEUM: fJM le.MIDGRADE UNLEADED 40) 3.D ❑ 5.JET FUEL 6.AVIATION GAS OLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM S eci : a4ce NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM $ i : 4491, IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL 15 2.DOUBLE WALL ❑ 95.UNKNOWN 443 PRIMARY CONTAINMENT ❑ 1.STEEL -P-3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444 ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER (specify): 444. SECONDARY CONTAINMENT ❑ 1.STEEL FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7 JACKETED 445 ❑ 90.NONE 0 95.UNKNOWN ❑99.OTHER(Specify) 445. OVERFILL PREVENTION 1.AUDIBLE&VISUAL ALARMS U 2.BALL FLOAT 3.FILL TUBE SHUT-OFF VALVE 452. fD 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑1.SINGLE-WALLED M DOUBLE-WALLED ❑99.OTHER 460 SYSTEM TYPE ❑ I.PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR§2636(a)(3)] 459 PRIMARY CONTAINMENT ❑ 1.STEEL CiF4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC q64 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Speoi : 461. SECONDARY CONTAINMENT ❑ 1 STEEL 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464b ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify) 464c PIPMGlfURBINE CONTAINMENT SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464d VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT 1.S7EEI. ❑ 4.FIBERGLASS 0 10.RIGID PLASTIC 13 90.NONE 0 99.OTHER(Specify) 464. 464.1 VENT SECONDARY CONTAINMENT 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE 99.OTHER(Specify) 464F 464 VR PRIMARY CONTAINMENT STEEL ❑ 4.FIBERGLASS In 10.ACID PLASTIC 0 90.NONE El 99.OTHER(Specify) 4649 464 1 VR SECONDARY CONTAINMENT I STEEL 4.FIBERGLASS ❑ 10.RIGID PLASTIC 90,NONE CT 99.OTHER(Specify) 46ab 464n1 VENT PIPING TRANSITION SUMP TYPE 0 1.SINGLE WALL 2.DOUBLE WAIL ❑ 90.NONE 4641. RISER PRIMARY CONTAINMENT 0 1.STEEL 4.FIBERGLASS U 10.RIGID PLASTIC El 90.NONE ❑ 99.OTHER(Specify) q4 RISER SECONDARY CONTAINMENT 0 1.STEEL EL4.FIBERGLASS 10.RIGID PLASTIC 90.NONE 0 99.OTHER(Specify) 41" I 464k1 I FILL COMPONENTS INSTALLED ❑ 1.SPU L BUCKET ❑ 3.STRIKER PLATEBOTTOM PROTECTOR El 4.CONTAINMENT SUMP 451. j VII.UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ❑ 1.SINGLE WALL 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469+ CONSTRUCTION MATERIAL ❑ 1.STEEL 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER S 4691,4 VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION ae. IX. PPLICANT SIGNATURE .CERTIFICATION: I certify that this U system is comp tib ith the hazardous substance stored and that the information provided herein is true,accurate, antl in f com li c with lee a u' APPLICANT SIGNATURE/ DATE O 470 APhtPLICANTN � -J-h 4 4n. APPLICANT T,Lq' 1f".'� 4n. UPCF UST-B I/2 Y f r 4.t<.1 1•U'v(.l Rev.(12!2007)