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IFIED PROGRAM CONSOLIDATED F41 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 Sectionsl,II,III,IV,and IX below) 430 ❑ 1.NEW PERMIT ® 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.USE PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DATE USE PERMANENTLY CLOSED: 410a DATE EXISTING USE DISCOVERED: 'Mb I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) Emil's Liquor&Sport Sho BUSINESS SITE ADDRESS 103 CITY 104 1405 California Street Escalon 95320 11.TANK DESCRIPTION TANK ID# 87 412 TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK IS 434 390002314850506698 Trusco ❑1.ASTAND-ALONE TANK ®2.ONE M A COMPARTMENTED UNIT. Complete one page for inch compartment in the unit. DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 7/31/1997 20,000/11,000 3 111.TANK USE AND CONTENTS_ TANK USE 0 la.MOTOR VEFIICLE FUELING C3 lb.MARINA FUELING ❑ Ic.AVIATION FUELING 439 0 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) [1 5.EMERGENCY GENERATOR FUEL fHSC§252819(.)] 0 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN 0 99.OTHER (Specify): 439. CONTENTS PETROLEUM: W Ia.REGULAR UNLEADED 0 In.MIDGRADE UNLEADED 0 Ib.PREMIUM UNLEADED 449 0 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9,OTHER PETROLEUM (Specify): 440. NON-PETROLEUM:0 7.USED OIL 0 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM S ecify): 440b IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 95.UNKNOWN 443 PRIMARY CONTAINMENT 0 1.STEEL 0 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444 0 7.STEEL+INTERNAL LINING 0 95.UNKNOWN 0 99,OTHER (Specify): 444a SECONDARY CONTAINMENT ❑ 1.STEEL 0 3.FIBERGLASS 0 6.EXTERIOR MEMBRANE LINER 0 7.JACKETED 445 ❑ 90.NONE ❑ 95.UNKNOWN ❑99+OTHER(Specify): 445a OVERFILL PREVENTION 1.AUDIBLE&VISUAL ALARMS 0 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 0 I.SINGLE-WALLED ®2.DOUBLL-WALLED 0 99.OTHER 460 SYSTEM TYPE ❑ I.PRESSURE ❑ 2.GRAVITY_E13.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION 123 CCR g2636(s)(3)I 458 PRIMARY CONTAINMENT ❑ L STEEL 0 4.FIBERGLASS 0 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464 ❑ 90.NONE 0 95.UNKNOWN 0 99.OTHFR(Specify): 464. SECONDARY CONTAINMENT 0 1.STEEL 0 4.FIBERGLASS 0 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464b ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c PIPING/TURBINE CONTAINMENT SUMP TYPE ❑ I.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464d VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ® I.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464e 464e1 VENT SECONDARY CONTAINIMENT ® 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464f VR PRIMARY CONTAINMENT 46411 ® L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464g 4tA I VR SECONDARY CONTAINMENT ® I.STEEL ❑ 4.FIBERGLASS 0 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464h VENT PIPING TRANSITION SUMP TYPE 464h1 ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 90.NONE 4641. RISER PRIMARY CONTAINMENT LJL STEEL 0 4.FIBERGLASS ❑ 10.RIGIDPLASTIC 0 90.NONE 0 99.OTHER(Specify) 464j 464'1 RISER SECONDARY CONTABiMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.R[GID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464k FILL COMPONENTS INSTALLED464kI ❑ 1.SPB,L BUCKET ❑ 3.STRIKER PLATE/BOTTOM PROTECTOR ❑ 4.CONTAINMENT SUMP 451.-c VII.UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE 59 1.SINGLE WAIT ® 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469u CONSIRUCTION MATERIAL ❑ L STEEL 0 4.FIBERGLASS ❑ 10.RIGID PLAS'T'IC ❑ 99.OTIIER(Specify) 4691+. VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODES) ❑ 4_IMPRESSED CURRENT ❑ 6.ISOLATION - 4448 IX. APPLICANT SIGNATURE CERTIFICATION: I certify that this UST system is compatible with the hazardous substance stored and that the information provided herein is true,accurate, and in full compliance with Ie al re uiremepts. APPLICANT SIGNATURE DATE $/3/2011 470. APPLICANT NAME(print) Linda Martin 471. APPLICANT TITLE Manager a72. UPCF UST-B-1/2 Rev.(12/2007)