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Ak AL IIW UNIFIED PROGRAM CONSOLIDATED b..RM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION(one form per UST) TYPE OF ACTION (Check one item only. For an UST permanent closure or removal,complete only this section and Sections I,II,]II,IV,and IX bel W) 430 El I.NEW PERMIT ❑ 3.RENEWAL PERMIT ® 5.CHANGE OF INFORMATION r( n El 6.TEMPORARY UST CLOSURE El 7.UST PERMANENT CLOSURE ON SITE El S.UST REMOVAL xp` D DATE UST PERMANENTLY CLOSED: 4J0a I DATE EXISTING UST DISCOVERED: 4306 I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) I BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 Spirit Gasoline BUSINESS SITE ADDRESS 103 CITY 104 1250 North Wilson Way Stockton IL TANK DESCRIPTION TANK ID# 1 Prem `r C^l Y)432 TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK IS 434 Modem Welding ® I.ASTAND-ALONE TANK © d ["�,t ry / El 2.ONE M A COMPARTMENTED UNIT. .J ` .J (7 Co tete one elE for each cam artment in the unit. DATE UST�YSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THH UNIT 437 'I.1 L / q 12,000 1 III. TANK USE AND CONTENTS TANK USE N la.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ le.AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE Bwludes Used oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§25281.5(e)] { ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 439. CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED N Ib.PREMIUM UNLEADED 440 ❑ 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): 4406 IV. TANK CONSTRUCTION TYPE OF TANK ❑ I.SINGLE WALL N 2.DOUBLE WALL ❑ 95.UNKNOWN 443 PRIMARY CONTAINM ENT N L STEEL ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444 ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 444. SECONDARY CONTAINMENT N 1.STEEL ❑3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445 ❑ 90.NONE ❑ 95.UNKNOWN ❑99+OTHER(Specify): 445a- OVERFILL PREVENTION ® 1.AUDIBLE&VISUAL ALARMS ❑ 2.BALL FLOAT ❑ 3.FILL TUBE SIIUT-OFF VALVE 452. ❑ 4.TANK MEETS REQUIREMENTS 17OR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑E SINGLE-WALLED N 2.DOUBLE-WALLED [199.OTHER 460 SYSTEM TYPE N 1.PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR§2636(a)(3)] 458- PRIMARY CONTAINMENT ❑ 1.STEEL N 4,FIBERGLASS ❑ &FLEXIBLE ❑ 10.RIGID PLASTIC 464 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTH ER(Specify): 464. '. SECONDARY CONTAINMENT ❑ L STEEL N 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 4646 1' ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c - PIPING/TURBINE CONTAINMENT SUMP TYPE ❑ 1.SINGLE WALL N 2.DOUBLE WALL ❑ 90.NONE 464d VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ L STEEL N 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90-NONE ❑ 99.O'fl IFR(Spwify) 464e 464el VENT SECONDARY CONTAINMENT ❑ 1.STEEL 4.FIBERGLASS ❑ 10.RIGID PLASTIC 90.NONE ❑ 99.OTHE2(Specify) 464E 46,111 VR PRIMARY CONTAINMENT ❑ L STEEL N 4..FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 4645 464 1 VR SECONDARY CONTAINMENT ❑ 7.STEEL 1 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify) 4,lh 464hl VENT PIPING TRANSITION SUMP TYPE L SINGLE WALL ❑ 2.DOUBLE WALL 1 t 90.NONE 4641, RISER PRIMARY CONTAINMENT 1.STEEL 14.FIBERGLASS ❑ 10.RIGID PLASTIC El 90.NONE ❑ 99.OTHER(Specify) 464j 464'I RISER SECONDARY CONTAINMENT ❑ I.STEEL N 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464k 464-1 FILL COMPONENTS INSTALLED N I.SPILL BUCKET (d 3.STRIKER PLATE/BOTTOM PROTECTOR 4.CONTAINMENT SUMP 45la-c VII.UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE N I.SINGLE W AI_I. ❑ 2.DOUBLE W ALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469, CONSTRUCTION MATERIAL ❑ L STEEL N 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 46Wb VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT 6.ISOLATION 44s. IX. APPLICANT SIGNATURE CERTIFICATION: 1 certify that this UST system is compatible with the hazardous substance stored and that the information provided herein is true,accurate, and in full compliance With le al re o.rements. APPLICANT SIGNATURE DATE 9/16/2009 479. APPLICANT NAME(print) Jojinder Lal J a 471 APPLICANT TITLE Owner/Operator 472. UPCF UST-B-1/2 Rev.(12/2007)