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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION(one form erUST) TYPE OF ACTION (Check one item only. For an UST permanent closure or removal,complete only this section and Sections I,II,HI,N,and IX below) 430 ❑ 1.NEW PERMIT ® 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION 6.TEMPORARY LIST CLOSURE 0 7,LIST PERMANENT CLOSURE ON SITE 8.UST REMOVAL DATE UST PERMANENTLY(LOSED: '130° I DATE EXISTING UST DISCOVERED: e3a 1. FACILITY INFORMATION FACILITY m#(.Ngear,,•¢,e o„ry) _ �s BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) Valley Pacific Petroleum Cardlock-Lodi BUSINESS SITE ADDRESS 103 CITY 930 E Victor Road Lodi 11.TANK DESCRIPTION TANK ID# C,;j V 7-16ei 432 TANK MANUFACTURER 433 :TANKC0NFTGu�UoN:ALONE TANKS TANK IsJlJ 7 Modern Welding N A COMPARTMENTED UNIT. [a each wtice wa. DATE UST SYSTEM INSTALL�p 435 TANK CAPACITY IN GALLONS d36 NUMBER OF COMPARTMENTS IN THE UNIT 2 437 y 1/98 3,000 Ili.TANK USE AND CONTENTS TANK USE N Is.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ Ic.AVIATION FUELING 439 ❑ 3 CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE Faelade Used DJ) ❑ 5.EMERGENCY GENERATOR FUEL 825281.5(c)] ❑ 6.OTHER GENERATO&ELML- Q 95.UNKNOWN ❑ 99.OTHER(Spaify): 43% CONTENTS PETROLEUM: M Ia.REGULAR UNLIADE13 ❑ Ic.MIDGRADE UNLEADED ❑ Ib.PREMIUM UNLEADED 440 ❑ 3.DIESEL' ❑ 5.FET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM S e : 4401 NON-PETROLEUM❑ Z USED OIL ❑ 10.ETHANOL ❑ I L OTHER NON-PETROLEUM(S ccifv}. 44ob IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SMGLF WALL 2.DOUBLE WALL C] 95.UNKNOWN n43 PRID1ARY CONTAINMENT I.STEEL ❑ 3.FIBERGLASS ❑ G.INTERNAL BLADDER 444 ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OITIFR S ci' : 444. SECONDARY CONTAINMENT Cl 1.STEEL 3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER 7.FACKETF.D 415 `, ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER IS2eeft2 445. OVERFILL PREVENTION N I_AUDIBLE&VISUAL ALARMS ❑ 2.IIALL FLOAT' N 3.FILL TUBE SHUT-OFFVAINE452 ❑ 4.TANK MELTS REQI)IP FNIP.VIS POR EXEMPIION FROM OVISRFILL PRIiN LNT10N EQUIPIVRNT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUC TION ❑ I.STNGIE-WALLED 2DOUBLF-WAILED ❑99.01HER 460 SYSTEM TYPE 1PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONALSUC_IlON ❑ 4.SAFESLICTT0NfVCCRg2636(.X3)I 458 PRIMARY CONTAINMENT ❑ 1.STEEL N 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464 ❑ 90_NONE ❑ 95.UNKNOWN ❑ 99.OT'HER(SpeaTy): 064" SECONDARY CONTAINMENT ❑ 1.STEEL Cg 4_FIBERGLASS ❑ &PLF%Nn E ❑ 10.RIGID PLASTIC 4641 ❑ 90.NONIi ❑ 95 UNKNOWN ❑ 99.OTHER(SpecifO 'mac PIPING/TURBINE CONTAINMENT SIMP TYPE I_SINGLE WAIL ❑ 2DOUBLE WALL ❑ 90 NONE 4644 VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CODTIAINMENI ❑ LSTILL 13 4.FIBFRCILAIC ❑ 10.RIGID PLASTIC ❑ 90.NONG 99.OTI LIR(Sp,,,() 46401 46Je1 VENT SECONDARY CONTAINMENT L STEEL 4.FIBERGLASS 10.RIGID PLASTIC' 90.NONE 99.OTHER(Specify) 464[ 4e4n VR PRIMARY CONTAINMENT L STEEL M 4.FIBERGLASS 10.RIGID PLASTIC 0 90.NONE ❑ 99 OTHER(Specify) 016"9 VR SECONDARY CONTAINMENT 0 L STEEL 0 4.FIBERGLASS 10.RIGID PLASTIC IN 90.NONE 999.OTHER(Specify) 46W 46461 VENT PIPING TRANSITION SUMP TYPE 0 1.SINGLE WALL 2,DOUBLE WALL 90.NONE 4611. RISER PRIMARY CONTAINMENT J21 L STEEL U 4.FIBERGLASS Lj 10,RIGID PLASTIC U 90.NONE U 99.OTHER(Specify) 4wi 4641 RISER SECONDARY CONTAINMENT 1.STEEL 4.FIBERGLASS 10.RIGID PLASTIC IN 90.NONE99.OTHER(SNrify) 464k1 III,[ COMPONFNTS INSTALLED I.SPILLBUCKIT 3.STRIKERPLAIE/BOTTOM PROTECIOk 4 i-ONIMNMENTSUMP Jnec VII.UNDER DISPENSER CONTAINMENT(UDC) CONS'IRUCI1ON TYPI 1.SINGLE WALL ❑ 2 DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE, 4699 CONSTRII(-ITUN MAIllUAL NI_STIFF, ❑ 4.FIBIRGIASS ❑ 10.RIGIDPLLSIK ❑ 99.OTIIFR(S ,ih) 46Wb VIII. CORROSION PROTECTION STEEL('OMPONLNI MOIL( 110N ❑ 2 SACRIFICIAI.ANODF(S) ❑ 4.IMPRESSI A I RREN 1 ® 6_I.SOLA110N 448_ IX, APPLICANT SIGNATURE CER FIFICATION: I certify that this UST system is compatible with the hazardous substance stored and that the information provided herein k true,accurate, L._ and in full compliance ith 1 al requirements. APPLICANT SIGNANL �-.:.. 470MAR 10 2012 . `, RE DATE3/20/2012 APPLICANT NAME(print) Mike Eliason 401. APPLICANT TITLE Cardlock Manager 4az tNPCF UST-8-12 Rev.(12/2007)