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Aft • VF UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION(One form per UST) 430 TYPE OF ACTION (Check one item only. For an UST permanent closure or removal,complete only this section 5 CHANGE OF INFORMATION IV,and IX below) ❑ 1.NEW PERMIT ❑ 3.RENEWAL PERMIT ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE [18.UST REMOVAL 430b DATE UST PERMANENTLY CLOSED: 430a 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 02076103 CITY 104 BUSINESS SITE ADDRESS LODI 800 E KETTLEMAN LN IL TANK DESCRIPTION 434 TANK ID# 3 432 TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK IS n 3 6 c� Xerxes ®1.A STAND-ALONE TANK �I ❑2.ONE IN A COMPARTMENTED UNIT. DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 1992/1 10,000 III.TANK USE AND CONTENTS TANK USE ® la.MOTOR VEHICLE FUELING El 1b,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 ❑ 6.OTHER GENERATOR FUEL [195.UNKNOWN [199.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 443 TYPE OF TANK ❑ 1.SINGLE WALL ® 2.DWN 444 PRIMARY CONTAINMENT ❑ 1.STEEL N 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444a ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER (specify): 445 SECONDARY CONTAINMENT ❑ 1.STEEL ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445a ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER Specify): 452. OVERFILL PREVENTION ® 1.AUDIBLE&VISUAL ALARMS ® 2.BALL FLOAT El 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 ®2.DOUBLE-WALLED ❑99.OTHER 458 SYSTEM TYPE N L PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR§2636(a)(3)] 464 PRIMARY CONTAINMENT ❑ L STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE 1310.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): 464d PIPING/TURBINE CONTAINMENT SUMP TYPE ® 1.SINGLE WALL El 2.DOUBLE WALL ❑ 90.NONE VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION 464e VENT PRIMARY CONTAINMENT ❑ L STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464el 464f VENT SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90. ONE [j99.OTHER(Specify) 464n 464g VR PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE [199.OTHER(Specify) q6ah t a6a VR SECONDARY CONTAINMENT ❑ 1.STEEL El 4.FIBERGLASS 1110.RIGID PLASTIC ® 90.NONE [1 99.OTHER(Specify) 464h1 4641. ify VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL [712.DOUBLE WALL ® 90.NONE 464, RISER PRIMARY CONTAINMENT ® 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Spec ) 4641 464k RISER SECONDARY CONTAINMENT ❑ 1.STEEL El 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify) 464kl FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET ® 3.STRIKER PLATEBOTTOM PROTECTOR E 4.CONTAINMENT SUMP 451a-c VII.UNDER DISPENSER CONTAINMENT(UDC) 469a CONSTRUCTION TYPE ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 4696-c CONSTRUCTION MATERIAL ❑ 1.STEEL E 4.FIBERGLASS [110.RIGID PLASTIC Li 99.OTHER(Specify) VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2 SACRIFICIAL ANODE(S) [34.IMPRESSED CURRENT ❑ 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 com liance with le al re uirements. 470 APPLICANT SIGNAT � DATE � 1-5- io APPLICANT NAME(print) NI F MARINAS 471. APPLICANT TITLE Environmental Compliance Specialist 472' UPCF UST-A Rev.(12/2007) �a_VO