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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUNDSTORAGETANK OPERATING PERMIT APPLICATION-TANK INFORMATION(One£inn r UST) TYPE OF ACTION (Check one item only. Foran UST Permaneat closure or removal,complete only this section and Sections I,B,III,IV,and IX below) 430 ❑ 1.NEW PERMIT ® 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION 6.TEMPORARY UST CLOSURE 7.LIST PERMANENT CLOSURE ON SITE El 8.UST REMOVAL 439h DA IT LIST PERMANENTLY CLOSED. -- I DATE EXISTING UST DISCOVERED: I. FACILITY INFORMATION FACll-ITY ID#(Agency Use Only) _ - 3 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) Valley Pacific Petroleum Cardlock-Lodi BUSINESS SITE ADDRESS 103 CITY 10i 930 E Victor Road 103 II.TANK DESCRIPTION TANK ID# f -7-7 / ,( 432 TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK IS 434 DQ 7-7b(v,/ ❑1.A STAND-ALONE TANK Modern Welding C&2,ONE IN A COMPARTMENTED UNff. fm ache Mlhe ace DATE UST SYSTEM INSTAL 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT Z 437 1/98 9.000 III.TANK USE AND CONTENTS TANK USE Is.MOTOR VEHICLE FUELING ❑ Ib_MARINA FUELING ❑ Ic_AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Meluda Used W) ❑ 5,EMERGENCY GENERATOR FUEL(HSC§25281,5(c)] ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 43% CONTENTS PETROLEUM: ® Is.REGULAR UNLEADED ❑ 1c.MIDGRADE UNLEADED ❑ Ib.PREMIUM UNLEADED 4w ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ S.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM (Specify): 44N NON-PETROLEI TM:[] 7.USED OIL D 10.ETHANOL ❑ 11 OTHER NON-PETROLEUM(S ecifv): 440h IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL M 2.DOUBLE WALL ❑ 95.UNKNOWN 443 PRIMARY CONTAINMENT IN I.STEEL ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444 ❑ 7.STEEL,INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER S ci 444• SECONDARY CONTAINMENT ElI.STEEL 3.FIBERGLASS [16.EXTERIOR MEMBRANE LINER 7.lA(KETED 445 ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHERS i : 145e OVERFILL PREVENTION ® I AUDIBLE&VISUAL ALARMS 2.BALL FLOAT 3.FILL LUBE SHUT-OFF VALVE 452. ❑ 4.TANK MEETS REQI TIRFMENTS FOR EXEMPHON FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑1.SINGLE-WALLED 2.DOUBLE-WALLED ❑99.OTHER 4w SYSTEM TYPE 1_PRESSURE ❑ 2_GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4_SAFE SU(HUN[23CCR§263HeH3)] 458 PRIMARY CONTAINMENT ❑ 1.STEEL 19 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464 0 90.NONE ❑ 95 UNKNOWN ❑ 99.ATHER(Speafy) 464• SECONDARY CONTAINMENT ❑ 1.STEEL M 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 46W ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99 OTHER(Specify). 4Mc PIPING/TURBINE C'O.N'I AINMENT SUMP TYPF. I.SINGLE WALL ❑ 2.DOUBLE WALL. NONI: 4Md VI.VENT,VAPOR RECOVERY(RIPER/FILL PIPE PIPING CONSTRUCTION VCNT PRIMARYCONTAINMIN'f D LSTEEL 4_PIBERGLA53 10_IUG ID PLASTIC ❑ 90 NONE 0 99.OTHER(SpccifO > 4We1 VENT SECONDARY CONTAINMENT 1_STEEL ❑ 4.FIBERGLASS 0 10.RIGID PLASTIC ❑ 90.NONE M 99,OTHER(SPecny) 461f 4WD VR PRIMARY CONTAINMENT 01.STEEL M 4.FIBERGLASS 0 10.RIGID PLASTIC 0 90,NONE 0 99.OTHER(Specify) 464E WI VR SECONDARY CONTAINMENT1.STEEL 4.FIBERGLASS 10.RIGID PLASTIC' 90.NONE 99.OTHER(Specify) 4Wh 4Mh1 VENT PIPING TRANSITION SUMP TYPE 1.SINGLE WALL 2,DOUBLE WALL 90.NONE 46,11. RISER PRIMARY CONTAINMENT Rat I.STEEL U 4.FIBERGLASS HU 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 4&11 46 1 RISER SECONDARY CONTAINMENT L STEEL 0 4_FIBERGLASS D 10.RIGID PLASTIC M 90,NONE 0 99 OTHER(Specify) 4Mk 4Wkl PILI.COMPONENTS INSTALLED I.SPILL BUCKET C& 3_STRIKER PLATEBOTTOM PROTECTOR 0 4.CONTAINMENT SUMP 01- VIL UNDER DISPENSER CONTAINMENT(UDC) ('ONS I RUCTION TYPE 1.SINGLE WAIL ❑ 2_DOUBLE W:AN I. ❑ 3.NO DISPENSERS ❑ 99 ION- Ie9e I ONSIRU(TIONMATERIAL [NI STEEL El4_FIBI:RGIASS ❑ 10,MUIDPLASHC' ❑ 99.ODIER(5 enol 469ha _._...____ _._.._......_-_- VIII. CORROSION PROTECTION SI1.11 ('OMPONINT PROTECTION ❑ 2.SACRIECIALANODF;(s) ❑ 1.[%IPRFSSED CURRENT IM 6.ISOLATION IX. APPLICANT SIGNATURE ('F,R I FI(-A'TION: I certify that this UST system is compatible with the ha2ardoas xubstance stored and that the iotormetion provided herein ix true,accurate, and in full com liance wl 1 al curements. APPLICANT SIGNATURE DATE - 470 3no/zolz APPLICANT NAME(print) Mike Elieson 471 APPLICANT TITLE Cardlock Manager an. UPCF UST-a-In Rev,(1212007)