BILLING 2010 - 2013 - Laserfiche WebLink

Home Browse Search

Alk UNDERGROUND STORAGE TANKNW OPERATING PERMIT APPLICATION-TANK INFORMATION(One form per UST) a3o TYPE OF ACTION (Check one item only. For an UST permanent closure or removal,complete only this section 5 CHANGE OF INFORMATION below) ❑ 1.NEW PERMIT E] 3.RENEWAL PERMIT ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL 430b "us DATE EXISTING UST DISCOVERED: DATE UST PERMANENTLY CLOSED: I. FACILITY INFORMATION I FACILITY ID#(Agency Use Only) - - 3 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) ARCO 02076 103 1 CITY 104 BUSINESS SITE ADDRESS LODI 800 E KETTLEMAN LN II.TANK DESCRIPTION 434 TANK ID# 2 432 TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK IS Xerxes ®1.A STAND-ALONE TANK ❑2.ONE IN A COMPARTMENTED UNIT. 437 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 ® la.MOTOR VEHICLE FUELING ❑ lb.MARINA FUELING El lc.AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§25281.5(c)] 439a [j6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 440 CONTENTS PETROLEUM: ® la.REGULAR UNLEADED ❑ lc.MIDGRADE UNLEADED ❑ lb.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 -343 TYPE OF TANK ❑ 1.SINGLE WALL E 2.DOUBLE WALL ❑ 95.UNKNOWN 444 PRIMARY CONTAINMENT ❑ 1.STEEL E 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 44aa [17.STEEL+INTERNAL LINING ❑ 95.UNKNOWN El 99.OTHER (Specify): 4a5 SECONDARY CONTAINMENT ❑ 1.STEEL E 3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445a ❑ 90.NONE [j95.UNKNOWN ❑99.OTHER(Specify): 452. LOVERFILL PREVENTION E 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 CONSTRUCTION ❑1.SINGLE-WALLED E2.DOUBLE-WALLED ❑99.OTHER 458 TYPE E LPRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION Iz3 CCR§2636(a)(3)] 46a Y CONTAINMENT ❑ 1.STEEL E 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464a ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464b SECONDARY CONTAINMENT ❑ 1.STEEL E 4.FIBERGLASS [38.FLEXIBLE ❑ 10.RIGID PLASTIC 464c ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464d PIPING/TURBINE CONTAINMENT SUMP TYPE E 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION 4644 VENT PRIMARY CONTAINMENT ❑ L STEEL ® 4.FIBERGLASS ❑ ]0.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 46441 VENT SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC E 90.NONE [3464f 99.OTHER(Specify) 4641 VR PRIMARY CONTAINMENT ❑ 1.STEEL E 4.FIBERGLASS ❑ 10.RIGIDPLASTIC 10390.NONE ❑ 99.OTHER(Specify) 4648 464 1 464h VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify) 464h1 464i. VENT PIPING TRANSITION SUMP TYPE El 1.SINGLE WALL [712.DOUBLE WALL ® 90.NONE 464j RISER PRIMARY CONTAINMENT E 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464'1 RISER SECONDARY CONTAINMENT ❑ I.STEEL [1IB 4.FERGLASS ❑ 10.RIGID PLASTIC E 90.NONE ❑ 464k 99.OTHER(Specify) 464kl FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET E 3.STRIKER PLATE/BOTTOM PROTECTOR E 4.CONTAINMENT SUMP 451 a-c VII.UNDER DISPENSER CONTAINMENT(UDC) 469a CONSTRUCTION TYPE ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE g696-c CONSTRUCTION MATERIAL ❑ L STEEL E 4.FIBERGLASS El 10.RIGID PLASTIC ❑ 99.OTHER(Specify) VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT E] 6.ISOLATION 448. 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 SIGNATURE DATE ' _5_ 10 APPLICANT NAME(print) NIF . MARINAS 471' APPLICANT TITLE Environmental Compliance Specialist 472. UPCF UST-A Rev.(12/2007)