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Oi I1`,dF'IED PROGRAM CONSOLIDATED FOIA %'Ai✓ UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION (One form per UST) TYPE OF ACTION (Check one item only. For a UST closure or removal,complete only this section and Sections 1,11,111,IV,and IX below) 430. ❑ 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: 430x. DATE EXISTING UST DISCOVERED: 4366. I. FACILITY INFORMATION FACILITY ID 4(Agency Use Only) I. BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3. FLAG CITY ARCO/SUBWAY BUSINESS SITE ADDRESS 103. CITY lw. 14931 NORTH FLAG CITY BLVD. LODI, CA 95242 IL TANK DESCRIPTION TANK ID R 432- TANK MANUFACTURER 4331 TANK CONFIGURATION:THIS TANK IS 434. TA0506223 ❑ L A STAND-ALONE TANK Complete one page for ach ❑ 2.ONE IN A COMPARTMENTED UNIT compartment in the unit DATE UST SYSTEM INSTALLED 435. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS IN THE UNIT 437 4/1/1997 10,000 III. TANK USE AND CONTENTS TANK USE N la.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ Ic.AVIATION FUELING 439. ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Induta Used Oil ❑ 5.EMERGENCY GENERATOR FUEL[HSC§252815(c)) ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 4399. CONTENTS PETROLEUM: ❑ la REGULAR UNLEADED ® Ic MIDGRADE UNLEADED ❑ 16 PREMIUM UNLEADED 446. ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ S.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM(Specify): 446a---- NON-PETROLEUM ❑ 7.USED OIL ❑ 10 ETHANOL ❑ 11,OTHER NON-PETROLEUM ISEify) 44ob. IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL N 2.DOUBLE WALL ❑ 95.UNKNOWN 443. N _...._.......... ......... ..........._. B "'-"_. _....__....... ................ ....R--__.._._ ..._....... 1111._ 1111... ...........--- PRIMARY CONTAINMENT ❑ 1.STEEL N 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444. _ ❑ 7.STEEL+ NTER_N_AL LINING ❑ 95.UNKNOWN ❑ 99.OTHER(Specify_); 4449. SECONDARY CONTAINMENT ❑ I STEEL N 3 FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445, ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specify): 445x. OVERFILL PREVENTION [I 1 AUDIBLE&VISUAL ALARMS ❑ 2 BALL FLOAT N 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 N 2.DOUBLE WALL ❑ 99.OTHER 460. ......... _- ....... _. 1111. ............_. . _........ .__-_------"'_. SYSTEM TYPE N 1 PRESSURE __� 2,GRAVITY ❑ 3_CONVENTIONAL SUCTION. ❑ 4 SAFE,SUCTION[23 CCR§2636(a)(3)) _458:_ PRIMARY CONTAINMENT ❑ L STEEL N 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ lo.RIGID PLASTIC 0 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464a 1 . SECONDARY CONTAINMENT ❑ STEEL N 4.FIBERGLASS [18.FLEXIBLE ❑ 10.RIGID PLASTIC 4646. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c. PIPING/TURBINE CONTAINMENT SUMP TYPE E3 1.SINGLE WALL N 2.DOUBLE WALL ❑ 90.NONE 464d. VI. VENT, VAPOR RECOVERY (VR) AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ I STEEL N 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 4444 _.-- ..11.11...... ............... ......... ____.__. ...__......... .. ......... ________ ............. ___.___. 4�-I . VENT SECONDARY CONTAINMENT ❑ 1 STEEL N 4 FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464fl -___ ___ __ __.. ....._......... ....... �____... . .......:. 44fl VR PRIMARY CONTAINMENT ❑ I STEEL N 4 FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90NONE ❑ 99.OTHER(Specify) 464 8 1111... ... ...... 1111... ........ _._____ ........... 11.11. ... ......... -----..... 1111........:. __s....... VR SECONDARY CONTAINMENT ❑ 1.STEEL N 4 FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 4464Mh1 ----------- -......... ...._._______ . .. ._______ ........... ...___-_._. .. .....------_ 4�'.... VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL N 2.DOUBLE WALL ❑ 90.NONE _.._._....._.11_______11 ................ .........----------------- ....__ ..._......... 1111............__ ............. 1111 ... 11_11____ .............------____. RISER PRIMARY CONTAINMENT ❑ 1 STEEL N 4 FIBERGLASS ❑ 10:RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Spxify): 4646047��' _ .. -......... ................ ........ ......__---' .......... .. 1.O RISER SECONDARY CONTAINMENT ❑ I STEEL N 4 FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify)' 4641. .._......... ..-...._. 46411. .......... ___.1__111 ._....S FILL COMPONENTS INSTALLED ❑ 1.SPILL BUCKET ❑ 3.STRIKER PLATE/BOTTOM PROTECTOR ❑ 4.CONTAINMENT SUMP 451 a-c. VII. UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE ❑ I.SINGLE WALL N 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE "At .......... 111O .. .................. 1111... __. .............. ...........9 .__ . 1111. ............. ____....... CONSTRUCTION MATERIAL ❑ 1.STEEL N 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 4696. 469c VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION 449. IX. APPLICANT SIGNATURE CERTIFICATION: 1 certify that th' S system is compatible with the hazardous substance stored and that the information provided herein is true, ,a accurs d' f I iypnplihocewithjegidequirernents. APPLICANT SIGNATUR DATE 6/25/2010 470 ' APPLICANT NAME(print) IF HALLOUM 471- APPLICANT TITLE OWNER 472. UPCF UST-B Rev.(12/2007)-1/2 www.unidoes.org