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FIED PROGRAM CONSOLIDATED FO <br /> UNDERGROUNDSTORAGETANK <br /> OPERATING PERMIT APPLICATION-TANK INFORMATION (One forth per UST) <br /> TYPE OF ACTION (Check one item only. Fora UST closure or removal,complete only this section and Sections I,I!,I/I,IV,and IX below) <br /> 430. <br /> ❑ 1.NEW PERMIT 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION <br /> ❑ 6.TEMPORARY UST CLOSURE 7.UST PERMANENT CLOSUREON SITE <br /> EXISTING UST DISCOVERED:8.USTREMOVAL <br /> g306. <br /> DATE UST PERMANENTLY CLOSED: 430.. ATE <br /> L FACILITY INFORMATION <br /> FACILITY ID#(Agency Use Only) <br /> 3. <br /> BUSINESS NAME(Sa as FFaacdftyName r A-Doir�Busi SAS) '` <br /> Ilia/ e3 104. <br /> BUSIN SS S T AD RESS 103. CITY St�6 /, lw <br /> /qA K 7 <br /> II. TANK DESCRIPTION <br /> TANK ID# '-/ 432. TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434. <br /> / va'l� �p�'J ?�If J,(iYl f /L6 fit7/7l [ each <br /> p is ONEAIN AA COMPARTNE M <br /> ENTED T ENTED UNIT cb v'"`�a`-tea er t <br /> c artmm�P,for. <br /> DATE UUST SSYS INSTALLED 43s. TANK CCAACAPACCIITTY IN GALLONS 436. NUMBER OFF CCO MPARTMENTS IN THE UNIT <br /> STIL 43]. <br /> wV4 <br /> III. TANK USE AND CONTENTS <br /> TANK USE a.MOTOR VEHICLE FUELING ❑ Ib.MARINAFUELING ❑ 1c.AVIATION FUELING 439El . <br /> 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Uscd Gil) Q 5.EMERGENCY GENERATOR FUEL[HSC§25281.5(c)] <br /> Q 6.OTHER GENERATOR FUEL 0 95.UNKNOWN 0 99.OTHER(Specify): 439... <br /> CONTENTS PETROLEUM: a.REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ❑ Ib.PREMIUM UNLEADED 440' <br /> �❑ 3�------.DIESEL 5.JET FUEL ❑ 6.AVIATION GAS <br /> _ ❑ 8.PETROLEUM BLEND FUEL _(]9.071iER PETROLEUM(Specify): �. <br /> NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL <br /> ❑ <br /> 11.OTHER NON-PETROLEUMS i : amu'. <br /> IV. TANK CONSTRUCTION <br /> _TYPE OF TANK_ 0 1.SINGLE WALL .DOUBLE WALL ❑ 95.UNKNOWN _ ___ �3 <br /> PRIMARY CONTAINMENT ❑ 1.STEEL 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444. <br /> Q 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER(Specffy).. 444a <br /> SECONDARY CONTAINMENT ❑ 1.STEEL FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER El7.JACKETED 445' <br /> 90.NONE 95.UNKNOWN _ Q 99.OTHE_R_(Specif445.. <br /> -y): ______. <br /> OVERFILL PREVENTION AUDBLE&VISUAL ALARMS t-B..2.BALL FLOAT ❑ 3.FILL TUBE SHUT-OFF VALVE 452. <br /> 4.TANK MEETS RE IJIIiEMfENTS FOR EXEMPTION PROM OVERFILL PREVENTIONE UIPMENT <br /> V. PRODUCT/WASTE PIPING CONSTRUCTION <br /> PIPING CONSTRUCTION ❑ I.SINGLE WALL 2_DOUBLE WALL 0 9999.OTHER _ 458. <br /> _-- -- 458. <br /> SYSTEM TYPE___:1.PRESSURE ___02.GRAVITY __-_ __CONVENTIONAL SUCTION_� 4_SAFE SUCTION(23 CCR 52636(a)(3)] _ _ <br /> PRIMARY CONTAINMENT Q 1.STEEL Q 44.FHIERGLASS �.8.FLEXIBLE ❑ 10.RIGID PLASTIC � <br /> Q 90.NONE ❑ 95.UNKNOWN_ Q 99.0THER(Specify): - <br /> SECONDARY CONTAINMENT Q 1.STEEL ---[1 4.FIBERGLASS ----W.FLEXIBLE <br /> ❑ I0.RIGID PLASTIC 4846' <br /> XI <br /> ❑ 90.NONE_ Q-95_UNKNOWN Q 99.OTHER(Specify): 4 ' <br /> PIPING/TURBINE CONTAINMENT SUMP TYPESINGLE WALL [12.DOUBLE WALL ❑ 90.NONE 464d' <br /> VI. VENT, VAPOR RECOVERY (VR)AND RISER/FILL PIPE PIPING CONSTRUCTION <br /> 46x. <br /> VENT PRIMARY CONTAINMENT ❑ 1.STEEL %4.FIBERGLASS ❑ 10.RIGID PLASTIC Q 90.NONE ❑ 99.OTHER(Specify)_ 464.1. <br /> VENT SECONDARY CONTAINMENT ❑ 1.STEEL M4.FIBERGLASS Q M RIGID PLASTIC _❑ 90.NONE_❑ 99.OTHER(Specify): 464}1. <br /> __ _ 464g. <br /> VR PRIMARY CONTAINMENT Q 1.STEEL �A.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90_NONE ❑ 99.OTHER(Specify): q 1. <br /> ...____---- -_..- --_-- 4646. <br /> VR SECONDARY CONTAINMENT Q 1_STEEL4.FH3ERGLASS Q 10.RIGIDPLASTIC I--] 90.NONE ❑ 99.OTHER(Specify): 4601. <br /> VEM PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL �'90.NONE <br /> RISER PRIMARY CONTAINMENT ❑ 1 STEEL IT4.FIBERGLASS ❑ 10.RIGID PLASTIC Q 90.NONE ❑ 99.OTHER(Specify): 4641. <br /> k. <br /> RISER SECONDARY CONTAINMENT ❑ 1.STEEL [14.FIBERGLASS ❑ 10.RIGID PLASTIC �M.NONE ❑ <br /> 99.OTHER(Specify): 464d6kl. <br /> FILL COMPONENTS INSTALLED 1.SPILL BUCKET 3.STRIKER PLATE030TT'OM PROTECTOR .CONTAINMENT SUMP <br /> 451a<. <br /> VII. UNDER DISPENSER CONTAINMENT (UDC) <br /> x9n <br /> CONSTRUCTION TYPE 1.S ------------- .__ -._- 4696. <br /> CONSTRUCTION MATERIAL ❑ 1.STEEL ❑ 4.FIBERGLASS 10.MGIDPLASTIC __Q_99.OTHER.(Specify) ___ x9c. <br /> VIII. CORROSION PROTECTION <br /> STEEL COMPONENT PROTECTION Q 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION 448' <br /> IX. APPLICANT SIGNATURE <br /> CERTIFICATION: I certify that this UST system is compatible -11he hazardous substance stored and that the information ovided herein is true, <br /> accur m coomilatiFe-w-Fh-leED req ments. <br /> APPLICANT SIGNATURE DATE <br /> 06 ai 2�9 <,0. <br /> � 4]2. <br /> APPLICANT NAME(pri ' 7�� #I 411' APPLICANT TITLE ���te <br /> UPCF UST-B Rev.(12/2007)-112✓ www.unidocs.org <br />