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Ask LWINWIED PROGRAM CONSOLIDATED FO UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION (One form per UST) E�.rEOACTON (Check one item only. For a UST closure or removal,complete only this section and Sections 1,11,111,IV,and IX below) 430. ❑ 1.NEW PERMIT ❑ 3.RENEWAL PERMIT ® 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 430. 1 DATE EXISTING UST DISCOVERED: 430b. I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) _ _ 1 BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3. Pacific Gas and Electric Company, Stockton Service Center BUSINESS SITE ADDRESS 103. CITY 104. 4040 West Lane Stockton II. TANK DESCRIPTION TANK ID# 432. TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434. U(q b`3 o Modern Welding ® 1.A STAND-ALONE TANK Complete one page for each ❑ 2.ONE IN A COMPARTMENTED UNIT compartment in the unit. DATE UST SYSTEM INSTALLED 435. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS IN THE UNIT 437, 9 5 y 10,000 i III. TANK USE AND CONTENTS TANK USE ® la.MOTOR VEHICLE FUELING ❑ 1b.MARINA FUELING ❑ lc.AVIATION FUELING 439. ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§25281.5(c)] ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 439a. CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED ❑ lc.MIDGRADE UNLEADED ❑ lb.PREMIUM UNLEADED a4o. ® 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM(Specify): 440a. ..........----..........._.............................._....__..__...._................. ..........._............._.......... ..... ..._._.. -..._..---.._.... ..__........ ................... .........._._.......... . NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 440b. IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 95.UNKNOWN 443 PRIMARY CONTAINMENT 1.STEEL ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER a4a. ❑ 7.STEEL+INTERNAL LINING _....._._......__.._......_..__�95.UNKNOWN I] 99.OTHER(Specify): 444a. -" ........_..._.. .._......-- --..._........._._....._..__........... SECONDARY CONTAINMENT 1.STEEL ❑3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445. ❑ 90.NONE ❑ 95.UNKNOWN [199.OTHER(Specify): 445a. OVERFILL PREVENTION ❑ 1.AUDIBLE&VISUAL ALARMS ❑ 2.BALL FLOAT ® 3.FILL TUBE SHUT-OFF VALVE asz. ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 99.OTHER 460. ................ SYSTEM TYPE ® L PRESSURE [12.GRAVITY ❑ 3.CONVENTIONAL SUCTION [14.SAFE SUCTION[23 CCR§2636(x)(3)] 458. ..................._......................._................_...._...................._........__............_......_..................................._....__.._.._..........._........_..................................................................................... PRIMARY CONTAINMENT ❑ I.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464a. ........._..._...................................................................................._.........._................................_..................................................................... ............................................ SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464b. _ ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 454c. ............_.................................................._.........._......................_..__...._................................... .._.._..._.........._._._.._..._._........ PIPING/TURBINE CONTAINMENT SUMP TYPE ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464d. VI. VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS [110.RIGID PLASTIC [190.NONE [199.OTHER(Specify): 464eel. . ...__.____.............__...._......__...._._..._....................................................._.-....................................._.._._....__..__.-.._...-_...._.............._................_......__..-.-.-............._............_._......_............._........_... _. VENT SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 4464fl -......_.. .._........ - --- ._._........___-.._.._-___._...---..........._.......................................................-..........................-..._..._..--...... --- ..........................._...._ ............ VR PRIMARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS [310.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 44688_ _.. ... - ..._....-- .................................................................---............._................................_..._....................................._..................... ---------- ' VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 46ah1. -'--................._.......----._..-. .......... ---- ............- ------....-----....................................................---..._.._......................................-......_.._..-.....-.._..---......................................--.....__....._.. ...._......_.... ............I......... VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE 46 --'----....__................._......._._........._...........__.._......__.____._....----------------.-,.__,.___.._._.._'-'---.........................................._...______'_............................................__._...........-...................................._......-_..........................._...----'------.-._.._.._...__......_.._.._-_............... ...... RISER PRIMARY CONTAINMENT ® 1.STEEL [14.FIBERGLASS [110.RIGID PLASTIC [190.NONE E3 99.99.OTHER(Specify):. 464 I ._..............................................................................................................._...................-......................_................................................................... ...........1.......... RISER SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 46 4 .k I ._.._...........-'-'-'-'---"-------'--...........................__....---.._.-_..._._..__.._...._.._........_..........._....._....._...._............................................................................._.............................._....... ..................__. FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET ® 3.STRIKER PLATE/BOTTOM PROTECTOR ❑ 4.CONTAINMENT SUMP 45la-c. VII. UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE -- ® 1.SINGLE WALL (] 2.DOUBLE WALL [3 3.NO ..... .................._..._ .........____. _.__ ._....-----------------_................... ..... ................ DISPENSERS 90 NOI 469a. .............................._.........._.__ _........ ..... .....4696. CONSTRUCTION MATERIAL ® 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGIDPLASTIC ❑ 99.OTHER(Specify) 469c VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.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 haefiQs true, accurate,an,4 in full co liance ith leg4 requirement. APPLICANT SIGNATURE DATE 11/24/2008 #A 470. APPLICANT NAME(print) M1Chelle m Le alt. APPLICANT TITLE Environmental Specialist :: 472 UPCF UST-B Rev.(12/2007)-1/2 www.unidocs.org