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06/10/2012 TUB 9108 FAX 05206 ®003/005 UNEnXD PROGRAM CONSOLIDATED FORM UNDERGROUNDSTORAGETANK OPERATING PERMIT APPLICATION-TANK INFORMATION(Ora farm per UST) TYPE OP ACTION (Check one item oWy. Foran UST pemnn%et olmum or Icahn ra4 complete only Oita aeOUon and Sect L It,W.IV,and IX eeioW) am ® 1.NEW PERMIT ❑ 3.RENEWAL PERMIT ❑ S.CHANGE OF INFORMATION El 6.TEMPORARY UST CLOSURE, 7.USTPERMANENTCLOSTJRBON SITS El &USTUMOVAL DATE USTPERMANSMLY CLOSED: ' °i DATE HXWTMOVST DISCOVSM: 49 FACILITY IDU PISmay Ute Onry) 1,;". +,�� a•. r . BUSINESS NAME(Same at PACUATYNAME or DBA-Doing Business As) 1 1819, 171 irlt tAas aw BUSINESS SITE ADDRESS tat CITY , 1250 North Wilson Way Stockton TANK IDU Talk I-Unlealed ffZ TANK MANUFACTURER a TANK CONFIGURATION:TEISTANKIB 04 Modem Weldigg 0 L ASTAND•ALONSTANK 2.ONE to ACOWARTMPNIBD UNIT. a I B 7$YS TA431 TANKCAPACTIVGALLONS 4 NUMBER OF COMPARTMENTS IN THE UNIT 411/95 15000 I . .',: 11l I! ..i: r • ,�'�. psl,.�. f0r ;.5...h+nl/.5•��/.a.LA%. f,• q ia,. TANK USE I&MOIORVffiOCIAPU&elft 1b.MARDfAPURI.MO IaAVtAT70NPUELINO 131c10aMtcALPROnuctSTORAGE Q 4.11AZABDOUSWASTIS(I. wUv 011) Q S.EMERGENCY GIiNERATOR FUSLImc I9azais(dl E3 o,oTw6R08NERA R 91.W'RWOWM 99.OTIOfR 4N. CONTENTS PETROLEUM; la.ReOUTARUNL-va la MWORADSUNWADED 16,PRBMtNM VNLBAORD 440, Q 1.DIESEL ❑ LIST FUEL Q 6.AVIATIONOAS B,PETROLEUM OUNDPUEM. 9.OTHERPETit UAN 4Na NONJSTROLSUMa T,USIB1O 10,BTNANOL It.I.DTTEEt140NLPST1tOLEUM f Noe :{5' LIt.LITH .L•. N49T OL u ' �.. : VI , ,01.3k et .•.a •( .� TVPEOPTANK ,• ❑ 1.6TNOLSWALL 7,DOI LE WALL ❑ 93.UNEWOWN 41 F M Y A1NMSNIT 29 1.STESL BRO 0. 4" Q 7.STEEL+GTTSRNAL LINING Q 95 .UNKNOWN Q 9A07TIR NN BC DARv N AINMENT 11 STEEL, 1,PIEEROLASS 1 EXtER10R MESSBRAN LO2ER 7.,lACXRTED NS 9Q NCNB 97,UNKN09M 99.OTTIER i i NA O 1.AUDIS $V AL ALAAMB 2.HALL AT 1.PILLTUB SHUT: P V VI ❑ 4.TANKMBM RBMBNTS FOR EXEMPTION FROM OVWU71.L PR13VBNIION •., � '.�; 'z r 1.SIWW BD 2.DOUBLE-WALLED ❑99.Oum 40 SYCFEMTYPE 99 I.PRESSURE Ll 2.GRAVITY Q 1.CONVERIT NAL SUCTION 8 4.SAFE SUCTION ra I:= I PRIMARY CONTAINMENT U LMEM 99 LFIBERGLASS Q 9.PLBXIRI.B 11 RIOW PLASM 9a NONE O/1 UlDCNOWN 99.OTMR 4a4 SECONDARY CONTAINMENT t.SI'®L 4.PfBBRf9uSB a.FtNSU81•11 Q m itlawrt ASTIC 4 9a NONE Q 9S,UNINOWN Q 99.oTTmR NN. P1PINWAIRETNE CObrr�AMtIEN }}NMT SUMP TYPE s�aatt 1.MN ELL WA2D UfBLBWALL gy1¢ayyttyy�s,S KNOWS .PYS, .:AWi :)• :! ya4!�+47t ! r j.�.f . •1 VENT PRIMARY CONTADIMBNT U I.67EEL 19 4.11mERGLASE U 1O.MiXOPLASTIC Ej 90.NONE U 99.OTHEH(Spaoify) •.0% VENT SECONDARY CONTAfWNW 13 1.MGL 0 &FIBERGLASS L3 10.11101D KNOWA Lf 99. (Spanify) "$f- VRMMARYCONTAJNMENT U t.•TESL 0 kPIE1911GLA19 0 t0.RIGID PLASTIC 0 KNONE U 99.OTHER(SpW ) a OaCONDA&V MNTXIMAR't Lj EVIME. ZIPJAIMEASs -775-51211151MVE 0 W NONE u a 67131 up_w1w__ 4 VENT PiprNo YKANETT69 sumpR 13 1.WiNaLIS WALL Cl 2.DOLUS WALL El 90. a RISKS PRIMARY OONTAINNIMT LJ 1.STEEL 29 4.FIBERGLASS LJ 10.RIGID PLAL'77C U 90.NONE LJ 9P.OTHER(Spcctry) LASER SECONDARY AI 1.STEEL 29 4.FISUOLASS 0 10-AIMPLASTIC 0 00.MONS Ea 99. 1 4fti ' PELCOMPONE1476 DIEI'ALL® 1.SPILL ISUCKSf 3 J.STRIKBRPLATNBOI•I'OM PROTP.CIOR 0 4.t:(1M'AE9l'dPNI'SUMP +Slee r'}y'.f 'Ll'A" CONSTRUCTION TYPB 1,SINGLE WAIL ❑ 21XRSBLR WALL �Y 7.NOTR8PINSERg 90.NONE COMIRUCTIUN MATIERML u 1.Frain 9.PIBP.RCLA99 10.R1DID PLASTIC 99. ,r• STEBLCOMFONENTPROTOCr10N Q ZRACRIPIMALANOVS(S 7yy,,}P,y .O LIMP SEDCURRENT Q LISOLATIN CERTIFICATIONt I earUQ'that Me UST apaaln bactrapitIblovkh the hourdou Mebib4a Mond add thatthe InMrutlod provided betelN L au%aeeuTne, and In full coo Ilancewith f reqNLrcmmf& APPLICANT SIGNATURE DATE 4 4M APPLICANTNAME(piot) loginderLal / •1 1' APPLICANTTITLR Operator N I1PCP usT-E-U: GJ' C�i