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Adlk UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATIOns IN(oIIIne form per UST) 430 TYPE OF ACTION (Check one item only. For an UST permanent closure or removal,complete only this section5.CHANGE OF INFORMATION and IX below) ❑ 1.NEW PERMIT ❑ 3.RENEWAL PERMIT tio ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL 43ob DATE UST PERMANENTLY CLOSED: DATE EXISTING UST DISCOVERED: I. FACILITY INFORMATION I FACILITY ID#(Agency Use Only) - 3 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) ARCO 02076 103 CITY loa BUSINESS SITE ADDRESS LODI 800 E KETTLEMAN LN II.TANK DESCRIPTION 433 TANK CONFIGURATION: THIS TANK IS a34 TANK ID# 1 a3z TANK MANUFACTURER Xerxes ®1.A STAND-ALONE TANK -,p () i 13{� l [-12.ONE IN A COMPARTMENTED UNIT. a37 DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 1992/1 10,000 III.TANK USE AND CONTENTS TANK USE ® 1 a.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ElIc.AVIATION FUELING a39 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§25281.5(c)] 439a [16.OTHER GENERATOR FUEL ❑ 95.UNKNOWN E] 99.OTHER (Specify): aao CONTENTS PETROLEUM: ® la.REGULAR UNLEADED ❑ lc.MIDGRADE UNLEADED [I 1b.PREMIUM UNLEADED ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS 440a ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM (Specify): NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL 440b ❑ 11.OTHER NON-PETROLEUM(Specify): IV. TANK CONSTRUCTION 44; TYPE OF TANK ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 95.UNKNOWN 444 PRIMARY CONTAINMENT ❑ 1.STEEL ® 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444a [17.STEEL+INTERNAL LINING ❑ 95.UNKNOWN E] 99.OTHER (S eci : 445 SECONDARY CONTAINMENT ❑ 1.STEEL ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445a ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specify): 752 OVERFILL PREVENTION ® 1.AUDIBLE&VISUAL ALARMS ® 2.BALL FLOAT ❑ 3.FILL TUBE SHUT-OFF VALVE ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION 460 PIPING CONSTRUCTION ❑1.SINGLE-WALLED N 2.DOUBLE-WALLED ❑99.OTHER 458 SYSTEM TYPE ® L PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR§2636(a)(3)] 464 PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464a ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464b SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464c ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): a6ad PIPING/TURBINE CONTAINMENT SUMP TYPE ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION a6ae VENT PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464el 464f VENT SECONDARY CONTAINMENT ❑ L STEEL [14.FIBERGLASS [310.RIGIDPLASTIC ® 90.NONE ❑ 99.OTHER(Specify) 464fl 464g VR PRIMARY CONTAINMENT ❑ L STEEL ® 4.FIBERGLASS ❑ 10.RIGIDPLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464 1 VR SECONDARY CONTAINMENT ❑ L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE [1 99.OTHER(Specify) 464h 464hl VENT PIPING TRANSITION SUMP TYPE E] 1.SINGLE WALL El 2. 2.DOUBLE WALL ® 90.NONE 46aj RISER PRIMARY CONTAINMENT ® L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) a641 RISER SECONDARY CONTAINMENT r_1L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE [1 99.OTHER(Specify) 4644 46441 FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET ® 3.STRIKER PLATE/BOTTOM PROTECTOR N 4.CONTAINMENT SUMP 45la-c VII.UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469 469a 9a CONSTRUCTION MATERIAL E] 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION aas. 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 legal requirements. azo. APPLICANT SIGNATDATE Ic UP6 �-k a72' APPLICANT NAME(pr]n ENNI M. MARINAS 471 APPLICANT TITLE Environmental Compliance Specialist UPCF UST-A Rev.(12/2007) '