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UNIFIED PROGRAM CONSOLIDATED F UNDERGROUNDSTORAGETANK OPERATING PERMIT APPLICATION-TANK INFORMATION(One four per UST) TYPE OF ACTION (Check one item only. For an UST permanent closurc or removal,complete only this section and Sections L IL UL IV,and IX below) 430 ❑ 1.NEN PERMIT ❑ 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION 6.TEMPORARY UST CLOSURE 7.UST PERMANENT CLOSURE ON SITE Q 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 43(d DATE EXISTING UST DISCOVERED: 9306 I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) BUSINESS AME(Same as FACILITY NAME or DBA-Doing Business As) 3 !a/tra G-2o BUSINESS S ADDRESS 2 IID CiN S � 109 II.TANK DESCRIPTION TANK ID# ��,,�sstt 433 TANK MANUFACTURER 433 TANK CONFIGURATION:THIS TANK IS 434 ALONE TANK 'TA OS-O* SOV ''/`USC0 LA ST IN COMPARTMENTED 92.ONE IH A COMPARTMENFED IIt,Tf, DATE US SYS M INSTALLED 43s TANK CAPACITY IN GALLONS 436 orc 6eexb Inarc Mis Z Q 2 Q 3 12 •PACI T) NUMBER OF COMPARTMENTS IN THE UNIT G7 III.TANK USE AND CONTENTS TANK USE 3 Ia.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ Ic.AVIATJON FUELING 439 [33.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE UoM,da Uvd w) El5.EMERGENCY GENERATOR FUEL[LSC 125381.5(c)] ❑ 6.OTHER GENERATORFUEL ❑ 95.UNKNOWN ❑ 99.-- 'Specify): 439a CONTENTS PETROLEUM: $ la.REGUf UNLEADED ❑ Ic.MIDGRADE UNLEADED ❑ A.PREMIUM UNLEADED 440 [1 3.DIESEL [1 5.JET FUEL [3 6.AVIATION GAS ❑ S.PETROLEUM BLIND FUEL ❑ 9.OTHER PETROLEUM S p9a NON-PETROLEUM:❑ 7.USED V6 ❑ !0.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 49ay IV. TANK CONSTRUCTION TYPE OF TANK ❑ I.SINGLEWALL 2.DOIIBLE WALL ❑ 95.UNKNOWN 993 PRIMARY CONTAINMENT �,1.STEEL ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 494 ❑ 7.STEEL-INTERNALLINING ❑ 95.UNKNOWN ❑ 99.OTHER (S ): 444a SECONDARY CONTAINb1ENT ❑ 1.STEEL 1.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER [I 7.JACKET® a5 ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTFIBR S OVERFI PREVENFION 1.AUDIBLE&VISUAL ALARMS 2.BALL FLOAT 3.FILL TUBE SHUT-OFF VALVE 452. ❑4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT✓WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑L SINGLE-WALLED K2.DOUBLE-WALLED ❑99,OTHER 460 SYSTEM TYPE I.PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION 23 CCR 42636(a)(3) 4M PRIMARY CONTAINMENT u 1.STEEL tW 4.FIBERGLASS ❑ S.FLEXIBLE ❑ 10.RIGIB PLASTIC 464 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Speeify): g6ge SECONDARY CONTAINMENT ❑ 1.STEEL A 4.FIBERGLASS ❑ S.FLEXIBLE ❑ 10.RIGID PLASTIC 4Mb ❑ 90.NONE [] 95.UNKNOWN ❑ 99.OTHER(Smcify): 46k PIPING/TURBINE CONTAINMENT SUMP TYPE I.SINGLE WALL ❑ 2.DOUBLE WALL 11 90.NONE 46W VI. VAPOR OR:RECOVERY(VR)AND RISER/FILL;PIPE PIPING CONSTRUCTION NT VENT PRIMARY COM AINMEI.STEEL 0 4.FIBERGLASS U 10.RJGID PLASTIC ❑ 90.NONE 0 99.OTHER(Specify) abae VENT SECONDARY CONTAINMENT 464e1 1.STEEL ❑ 4.FIBERGLASS 10.RIGID PLASTIC J•90.NONE 99.OTHER(Specify) 4641 464R VR PRIMARY CONTAINMENT ❑ 1.STEEL qk 4.FIBERGLASS 0 10.RIGH PLASTIC ❑ 90.NONE 99.OTHER(Specify) 4648 VR SECONDARY CONTAINMENT 0 1.STEEL 0 4.FIBERGLASS ❑ 10.RIGID-PUTT-1C--a-90-N0-NE-U-99-OnJER(Specify) 464h 4601 VENT PIPING TRANSITION SUMP TYPE 'I.SINGLE WALL 2.DOUBLE WALL 90.NONE 4641 RISER PRIMARY CONTAINMENT 1.STEEL 4.FIBERGLASS 10.RIGID PLASTIC 90.NONE0 99.OTHER(Specify) 464) 464'1 RISER SECONDARY CONTAINMENT 1.STEEL 4.FIBERGLASS In HL RIGIDPLASTIC JX 90.NONE 0 99.OTHER(Specify) 464k 464kl FILL COMPONENTS INSTALLED .SPILL BUCKET 3.STRIKER PLATFJBOTTOM PROTECTOR 4.CONTAINMENT SUMP 451. VII.UNDER DISPENSER CONTAINMENT.(UDC). CONSTRUCTION TYPE Z'1.SINGLE WALL ❑ 2.DOUBLE WALL [13.NO DISPENSERS ❑ 90.NONE 469+ CONSTRUCTION MATERIAL JR 1.STEEL C1 4.FIBERGLASS [I 10.RJGH)PLASTIC [1-99.OTHER(S i ) 469bc VIIL CORROSION.PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT 6.ISOLATION 448. DL APPLICANT SIGNATURE CERTIFICATION: I certify that this UST system is compatible with the hazardous substance stored and that the information Provided heerc(p »ae,accurate, and in full lccca/mupRJa�nce ith legal requirements. - :7 APPLICANT SIGMA"" DATE APPLICANT (P NAME-iinfjJX 471. , � APPLICANT T 4D. UPCF UST-B-1/2 #, Rev.(122007)