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CI /t2. IED PROGRAM CONSOLIDATED FOI`/ 1-7 it UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION- TANK INFORMATION (one tinrm per UST) TYPE OF ACTION (Check one item only. For a UST closure or removal,complete only this section and Sections 1,II,II(IV,and IX below) 430. ❑ 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: 43. 1 DATE EXISTING UST DISCOVERED: 430b. I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) 11 BUSINESSNAME(Same as Facility Name or DBA-Doing Business As) 3. FLAG CITY ARCO/SUBWAY BUSINESS SITE ADDRESS 103 1 CITY 104. 14931 NORTH FLAG CITY BLVD. LODI, CA 95242 II. TANK DESCRIPTION TANKID# 432. TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434. TA0506222 ❑ 1ASTAND-ALONE TANK Completeonepageforcteh ❑ 2.ONE INA COMPARTMENTED UNIT wmPentuou in the unit. DATE UST SYSTEM INSTALLED 435. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS M THE UNIT 437_ 4/1/1997 20,000 III. TANK USE AND CONTENTS TANK USE [0 la.MOTOR VEHICLE FUELING ❑ IF MARINA FUFLING ❑ Ic.AVIATION FUELING 439_ ❑ 3.CHEMICAL PRODUCISTORAGE ❑ 4_HAZARDOUS WASTE(Includes u.ed oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§252815(e)] ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 439.. .._______ _._. .......... _11-b- __ ......... CONTENTS PETROLEUM: ® Ia.REGULAR UNLEADED ❑ Ic MIDGRADE UNLEADED ❑ Ib PREMIUM UNLEADED 440. ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM(Specify): 440a. ------ .-__ _______ NON-PETROLEUM 0 7.USEDED OIL ❑ 10 ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 44W. IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 95.UNKNOWN 443_ PRIMARY CONTAINMENT ❑ I.STEEL ® 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444- ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN [1199.OTHER(Specify): 444a. SECONDARY CONTAINMENT ❑ .STEEL ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445 [1 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specify): 445+. OVERFILL PREVENTION ❑ L AUDIBLE&VISUAL ALARMS ❑ 2 BALL FL1.OAT ® 3.FILL TUBE SHUT-OFF VALVE 452. ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 99.OTHER 460. _._-.-.... .-...-- .... ________ ___-._-._ ... . ......... ..-.......- ......---" __..._....-._...-......-_ SYSTEM TYPE ® I.PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[v CCR$2636(aAA] 458 PRIMARY CONTAINMENT ❑ ISTEEL ® 4 FIBERGLASS ❑ S.FLEXIBLE [310.RIGID PLASTIC 464. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify). 464+ .... ......... ........._ SECONDARY CONTAINMENT ❑ I STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 4646 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 4Wa PIPINGFFURBINE CONTAINMENT SUMP TYPE ❑ 1 SINGLE WALL ® 2.DOUBLE WALL ❑ 90.NONE 464n_ VI. VENT, VAPOR RECOVERY (VR) AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ [I 9 90.NONE 9.OTHER(Specify): d46e( VENT SECONDARY CONTAINMENT ❑ 1 STEEL ® 4 FIBERGLASS ❑ 10.RIGIDPLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464A, _ - ..-.-.- _45a. VR PRIMARY CONTAINMENT ❑ I STEEL ® 4 FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90 NONE ❑ 99.OTHER(Specify) 4�e ....-.-.- ....................... ...--- VR SECONDARY CONTAINMENT ❑ I.S1ELL EI 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 464hh' ____..__ -...-....- _i54i. VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 90NONE ________ .................. RISER PRIMARY CONTAINMENT ❑ I STEEL ® 4 FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) ._.___..-. .............1. _--1'-.- RISER SECONDARY CONTAINMENT ❑ 1.STEEL ® 4 FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 4�L FILL COMPONENTS INSTALLED ❑ 1 SPILL BUCKET ❑ 3 STRIKER PLATE/BOTTOM PROTECTOR ❑ 4.CONTAINMENT SUMP 451+-c. VII. UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE ❑ I.SINGLF WALL ® 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469+- _.. ___. ______ -.-.-.-.- ................ .-.......... _._.__ CONSTRUCTION MATERIAL EI I.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC [0199.OTHER(Specify) 46% VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6_ISOLATION 448. IX. APPLICANT SIGNATURE CERTIFICATION: 1 certify a thi stem is compatible with the hazardous substance stored and that the information provided herein is true, accurst , i ul c liance with legal requirements. APPLICANT SIGNATURE DATE 6/25/2010 470, APPLICANT NAME(print) I HALLOUM 471, APPLICANT TITLE OWNER 472. UPCF UST-B Rev.(12/2007)-1/2 wiew.unidocs.org