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UNIFIED PROGRAM CONSOLIDATED FOTM UNDERGROUND STORAGE TANK 07 OPERATING PERMIT APPLICATION-TANK INFORMATION(one form m UST) TYPOF ACTION (Check one item only. For an UST penrument closure or removal,complete only this section and Sections I,II,III,IV,and IX below) ;4230 01.NEW PERMIT ❑ 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION 6.TEMPORARY UST CLOSURE El 7.UST PERMANENT CLOSURE ON SITE 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 4J9a DATE EXISTING UST DISCOVERED: 4306 I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 SNA ,+S-I- c[a,5 BUSINESS SITE F- REs1�� R m crrY S k/- 0 II.TANK DESCRIPTION TANK /SID# /� /� 432 TANK MANUFACTURER 433 ,T�A{ry,R CONFlGVRATION.TRISTANKLS 434 TK OrOry aO �Ti QU�'�'U L]��ASTANJYALONETANK 7 02.ONE IN A COMPARTMENTED UNfr. qe ma fm in Memt DATE T YSTE INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 02 10. 00 III:TANK USE AND CONTENTS TANK USE la.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING [3 Ic.AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(hwm Useb OiO ❑ 5.EMERGENCY GENERATOR FUEL pISC g25281J(c)j ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(S ): 43% CONTENTS PETROLEUM: ❑ la REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ❑ It.PRE MRIM UNLEADED 440 19 3.DIESEL ❑ 5.TET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM S 44(a NON-PETROLEUM:❑ 7.USED OI. ❑ 10.ETHANOL 11.OTHER NON-PETROLEUMS Npy IV. TANK CONSTRUCTION TYPE OF TANK 01.SINGLE WALL RR 2.DOUBLE WALL ❑ 95.UNKNOWN N3 PRIMARY CONTAINMENT 1.STEEL ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER N4 ❑ 7.STEEL+INTERNAL LINING ❑ 95.I1NKNOWN ❑ 99.OTHER SM' 44a SECONDARY CONTAUgMENT ❑ I.STEEL 3.FIBERGLASS ❑6.EXfERIOR MEMBRANELINER ❑ 7.JACKETED 445 ❑ 90.NONE 95.UNKNOWN ❑99.OTHER(S ): Nye OVERFILL PREVENTION 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 PIFING CONSTRUCTION ❑1.SINGLE-WALLED 2.DOUBLE-WALLED ❑99.OTHER qbp SYSTEM TYPE 2&I.PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION 4.SAFE SUCTION CCRf2636(a 3) 458 PR04ARY CONTAIN'NMNT ❑ 1.STEEL Eff 4.FIBERGLASS ❑ S.FLEXIBLE ❑ 10.RIGID PLASTIC 464 [190.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464a SECONDARY CONTAINMENT ❑ 1.STEEL 1(4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGIDPLASTIC 469b ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(S ): 46, PIPING111"INE CONTAINMENT SUMP TYPE 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 4644 VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT 0 1.STEEL '4 FIBERGLASS LJ 10.RIGID PLASTIC El 90.NONE 11 99.OTHER(Specify) 469e 46,1 VENT SECONDARY CONTAINMENT I.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC 0.NONE 99.OTHER(Specify) 4641 4Mfi VR PRIMARY CONTAINMENT C11.STEEL 4.FIBERGLASS 10.RIGID PLASTIC ❑ 90.NONE 99.OTHER(Specify) 4649 469 1 VA SECONDARY CONTAINMENT I.STEEL 4.FIBERGLASS [310.RIGID PLASTIC 90.NONE ❑ 99.OTHER(Specify) 4Nh 464h1 VENT PIPING TRANSITION SUMP TYPE L SINGLE WALL 2.DOUBLE WAW. 0.NONE 4Ni RISER PRIMARY CONTAINMENT 1.STEEL 4.FIBERGLASS 1 O.RIGID PLASTIC 90.NONE 0 11.OTHER(Specify) 464j RISER SECONDARY CONTAINMENT 1.STEEL 0 4.FIBERGLASS 10.RIGID PLASTIC .NONE 99461'1 .OTHER(Specify) 4Mk 464k1 FILL COMPONENTS INSTALLED I.SPILL BUCKET TZ.STRIKER PLATFIBOTI'OM PROTECTOR In 4.CONTAINMENT SUMP 451st VII.UNDERINSPENSER CONTAINMENT.(UDC) CONSTRUCTION TYPE 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469+ CONSTRUCTION MATERIAL M,I.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGIDPLASTIC ❑ W.OTHER(Specify) 4696 VIII. CORROSION.PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) [14.IMPRESSED CURRENT 6.ISOLATION 448. IX. APPLICANT SIGNATURE CERTIFICATION: I certify that this UST system is compatible with the hazardous substance stand and that the)nlbrm&thm pm-Aded herein h true,accurate, and In full compliance with legal requirements. APPLICANT SIGNATUe DATE �- / 61 470. - 470. APPLICANT NAME t) / APPLICANTTTTLE - 472. I 4-u Yer/ OV of e UPCF UST-B-1/2 �`: (1212007) E