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06/26/2012 TUE 10: 20 FAX 71 5206 1 1005/005 <br /> UNnUD PROGRAM CONSOLIDATED FORM ►f L9 1 Z U <br /> UNDERGROUND STORAGE TANK <br /> OPERATING PERMIT APPLICATION-TANK INFORMATION(One Berm per UST <br /> TYPE OF ACTION (Cheek one ilem only. For an UST permsnentclo9ure or romoval,completo onlythis section and Sections 1,114111,TV4 and IX below) <br /> ® L NEW PERMIT ❑ 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION <br /> E3 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CIASURB ON SITE Lj S.UST REMOVAL <br /> DATE UST PERMANENTLY CLOSED: 44{�30y. DATEExISTINGUSTDISCOVERED: °J4D <br /> .' ,' "A,'<}:ci q , .. :"W'ka, <br /> .uo:.... {�,I JT.i <br /> FACILITY ID;(Agency Uee Ona') "�" t''r•:' I <br /> (yYl1.I. <br /> BUSINESS NAME(Soma as FACILITY NAMBor DBA-Poing 9uaincaa A1) <br /> Spirit Gasoline <br /> BUSINESS SITE ADDRESS to CITY IN <br /> 1250 North Wilson Wa Stockton <br /> TANK @# Tank 3-Premium 432 TANK MANUFACTURER 51 TANK CONFIGURATION: THIS TANK IS 434 <br /> �� OG Modem Welding 01•ASTAND-ALONG TANK <br /> .J `l�� ❑2,ONE MACOMPARTMENTED UNIT <br /> - <br /> Co IcWo rhrmAzpffd,m%f 160 unit <br /> DATE UST SYSTEM INSTALLED 495 TANK CAPACITY IN GALLONS d16 NUMBER OF COMPARTMENTS INTHE UNIT 431 <br /> 4/1/95 12000 <br /> ' .LIZ..�' �rtt.. •a, .a ",•y.. .p. -., <br /> TANK USB ® Ia MOTOR VEHICLE FUELING Q MMAKINAPUBL(NG 0 Ia AVIATION FURLING n9 <br /> Q 3.CHEMICAL PRODUCT STORAGE 0 4.HAZARDOUS WASTE O,rcludm Umd oiO ❑ S.EMERGENCY GENERATOR FUEL(nSC 4D211.9111 <br /> ❑ 6.01INER GENERATOR FUEL Q 9S.UNKNOWN ❑ 99.OTHER ci : 43% <br /> CONTENTS PETROLEUM: Q II.ROOVLARUNLRAOEP Q Ie.MIDGRADBU,NLEADED M 1u PREMIUM UNLEADED 440 <br /> 0 3.DIESEL O 5.JET FUEL ❑ 6.AVIATION GAS <br /> Q F.PETROLEUM BLEND FUEL Q 9.OTHER PETROLEUM Oil : 4406 <br /> NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL <br /> I L OTHERNUN-7RTROLB��UMyy ((ryyy��e��lyy���yyn;�y 4406 <br /> .,4i0.1 .,�r y.„ ',4:•:'P+xs.�j.i'SFt\'#2Y;VNSM\4l%:1.W.V.ti•'..., :�':I' Ud.Jr.�r;gi'I'�:..J:n�h4v,'.::,[I'i•1�>L.y'u11l. `a�5 - <br /> TYPGOPTANK LSINOLEVJALL 2.000SLRWALL Q 93,UNKNOWN 441 <br /> PRIMARY CONTA(NMBNT ® I.STEEL U 3.FIBURGLASS U 6.1NTBRNALBLADDER 4d4 <br /> ❑ 7.STEEL a INTERNAL LINING ❑ 93.U14KNOWN Q 99.OTHSR S ecl 4444 <br /> SECONDARY CONTAINMENT 0 I.STEEL 0 1PIEPRULASS L3 5.EXTERIOR MEMBRANE LINER 7.JACKBT(4D 445 <br /> Q 90.NON' 9S.UNKNOWN ❑99.OTHER(S 401 44A <br /> OVMU-ILLPR15VENTION I.AUDI8LEd4VISUALALARMS UZAIALLILOAT 3.FILL TUBESNIJr-oFFVALVS 454. <br /> ❑ 4.'TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT <br /> PIPING CONSTRUCTION 0 1.SINGLE-WALLED 0 L DOUBLGWALLED ❑99.OTHER 460 <br /> SYSTEMTYPIS 07PRESSURS 0 2.ORAVITY tl 3.CONVENTIONALSUCTION 4.SAFE SUCTION 21 CCA 2656, 4 <br /> PRIMARY CONTAINMENT U I.STBEL 29 4.FIDEROLASS 0 a.PLEXIBLE 0 IO.RIOIDFLASTIC 454 <br /> 0 90.NONE 0 95.UNKNOWN n99.OTHERcoi : 4641 <br /> SECONDARY CONTAINMENT 0 LSTEEL MI 4.FIBERGLASS 0 6.FLEXIBLE ❑ IO.RIGIDPLASTIC +64 <br /> ❑ vo.NONR 0 91.UNKNOWN ❑ 99.OTHBR(S9041(y): 466 <br /> PIPINGRUREINE CONTAINMENT SUMP TYPE ❑ LSINGLEWALL R9 2.DOUBLE WALL ❑�09MUNI. <br /> O.NONE 444d <br /> YI.ykNT,.Y,YpkfQkl'REll? :! '12 ft' hi; :sSS.' 4•Yx. 2±` <br /> VENT PRIMARY CONTAINMENT 1.STERL 4.FIBERGLASS 10.RIGID PLASTIC 90.NONE 99.OT R(R(4wily) 4441 <br /> 464.1 <br /> VENT SECONDARY CONTAINMENT 0 1,STEEL 0 4.FIBBROL.ASS U 10.RIGID PLASTIC 0 90.NONE 0 99.OTHER(Speclly) 464( <br /> 444(1 <br /> VR PRIMARY CONTAINMENT 0 I.STEEL 0 4.F70L'ROLASS CI 10.RIGIP PW77C ti 90.N6N9 ti 99.0711BR(Speclly) 4649 <br /> W I <br /> VR SECONDARY CONTAINMENTIT MIM0 40 4.FIBEROLASS U 10.R101D PLASTIC El 90.NONE 0 99.0THER(epeoi(r) c44114641 <br /> VENT PIPING TRANSITION SUMP TYPE I.SINGLE WALL 2.DOUBLRWALL 0 90.NONE Sal <br /> RISER PRIMARY CONTAINMENT U I.STUL, Q9 4.FIRE14ULAS3 L8J 10.RIGID PLASTIC LJ 90.NONfl rT 99-OTHER(SpOCIN) 464) <br /> 4641 <br /> RISER SECONDARY CONTAINMENT 0 I,STEEL 0 4.FIBERGLASS Cl 10,RIOID PLASTIC 0 90.i NE El 99.OfHER(SPOOhy) 4641 <br /> 46411 <br /> FILL.COMPONENTS INSTALLED C9 I.SPILL BUCKET <br /> ®T 33L�..u67�6R.MERPLAT2P//BOTTOMPROTBCTOR 0 4.CONTAINMENTSUMP 451°•0 <br /> i ,,,I'S':Pei:12NAl+'+AKh'117/4'+'4� '�e5!. � 1 I I ,.:u.• \ > I/4 <br /> CONIMLIOMON TYPE ® 1.SINGLE WALL ❑ L DOUBLE W ALL ❑ 3.NO DISPENSERS 0 90•NONB ' , 469' <br /> CONSTRUCTION MATERIAL ❑ 1.STEEL 0 4.FIBERGLASS U 10,RIOID PLASTIC 0 99,OTHER oif 4694. <br /> r:.'- <br /> STCRLCOMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODES) y 04.1101PRESSL000RR6NT 0 6,ISOLATION 44L <br /> .' .'.:itA'Il�fi.47N'7.'I'.'N �!(Ai.',7'Vf.Yr�'. <br /> CERTIFICATION! 1 certify that ibis UST system Is compatible with the boxardous"balance stared and that the Information provided herein O true,accurate, <br /> and In fail com llanee with legal requircments. <br /> APPLICANT SIGNATURE k, O _\ _ Y _ (`1 DATE 4110/2012 471kAPPLICANT NAME(print) IGginder LEI loO" -Y 471' APPLICANT TITLE Operator 472. <br /> UPCFUST-B-1/2 <br />