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VQ/'V ZVLZ TOE 9109 FAX 70520fi • . <br /> �Q07/005 <br /> UNTRIED PROGRAK CONsouDATED FORM <br /> UNDERCROUNDSTORAGETANK <br /> OPERATING PERMIT APPLICATION-TANK MFORMATION ono fbmm er UST) <br /> TV B OF ACTION ((suck om item only. PM an US I Pwmvnmt c ar caeroval,conVim only TMs wtian and Secws L U.Ht N,m I w) uo <br /> ® <br /> I.NEW PERMIT 3.RENEWAL PERMIT O S_CHANGE OF INFORMATIO(d <br /> 6•TOMPORARYUSTCLOSURE 7,USTPBRMANSNT CLOSURE ON SITE S.UBTREMOF IN <br /> DATE VST FERMANRNTI.Y CLAIM: RATS SXISTINO UST DISCOVHRHIX <br /> PA ,I• 1••. ..1�:�. i ..�'N.r .�• 'l ' •�1'J i^ •ii <br /> dMCY VIS ONy) to .''• <br /> a V <br /> EUSRIESS NAME(Same M PAQLITY NAME a DBMpoing 40ainm0 As <br /> frit 02301ina <br /> BUSINESS SITE ADDRESS 103 CITY 104 <br /> 12SONort6 Wf1m WayStockton <br /> TANK IDN Ta tIY 3-Premium • • ANUPACTURER 413 TANK CONPIGURATTON:TNUTANR la u. <br /> Mod=Weld(Ig 01.A STAND-ALcNvTANK <br /> ❑:t'•ONB]N A r0MPAAT&%,NTED UNIT. <br /> DATE USC SYSTEM IN TA 1h..t <br /> ona <br /> T RI GALLONS O0 NUM13BROF M AR7MANTSINTH 431 <br /> 4/1195 12000 1 <br /> A 13.MOTOR VBNICLB FUELING 10.MARMAPURLMO ❑ Ie.AVIATIDNPURLING ` <br /> L3 3.c3�fICALPRODVCT S7'ORA03 Q I.HAZARDOUS WASTB(i.eN4..ueN0y1 [) 9.BM91UIBNCY OBN9RATOR FUEL Insc llnU s(0) <br /> S OTFIPAAOBN IOR PUBLC3 9S.UNKNOWN Q 99.07718E NSP. <br /> CONTM PBTROLBUMt Q Ia RBOULARUNLOADW Q ICMIDGRADBIINLEADBD M IQPlBM UNLEADED <br /> ❑ 7. 440 <br /> DIESEL ❑ STEP PURL ❑ ILAYIATION OAS <br /> &FECAOLBN SLBNDPVSL ❑ 0.OTHER PETROLEUM u0. <br /> N ROLB73M: LUSRDOIL 10.MHANOL <br /> 11,OTFDiRNUNgMaLBUM <br /> TYF5QrTANK Ur1.BMGLB WAIL T.DWIDIBWALL 99.UN n <br /> PRIMARY OONTAINMENP In 1.8193E U 3.MaRROLAss U 6,TNTUMALD ,)RR 994 <br /> 0 7.STEEL+INTERNAL LINING 93.1I19RP101YN ❑9P 1 444. <br /> SECONDARY CONTAINMENTU 1,BML .P LA99 SBR771RIORMBMHHANELINp,R 7.lACK919p 991 <br /> 90.NONE 9J.UNKNOWN 99.071138 i 4es <br /> OVBRWLLPR VSNTION LVE 447 <br /> 4VIS11ALALARMS 7.BALL A 1 T 9 T A <br /> 4,TANK MEETS RROHIRWO4111 POR BXBMPTgN'DOM OVBRPILLPREVBNTION S=pMHNT <br /> 'i B Ili' A A <br /> PIPING CONSTRUCTION i. L DOUBLB•WALLBD Q 99,O'DIBR 9W <br /> ,iSYSITISM Typo Q9 1.PRESSURE Q T.ORAVrrY 3. SV 4.8AF89LICTIOl7 <br /> PRIMARY CONTAaeot <br /> MMBM' 1. 4.PlBBAGLA99 e.FLEXIBLE 10.RIVIDPLA 464 <br /> 90.NONE Q 91 VNKNOWN ❑ 99. x las <br /> SECONDARY CONTAINMENT I. ® I.PIDHRDLAEB SPLW(IBLB Q 107( T)C <br /> 9MNON3 ❑ 91 UNKNOWN Q 99,OTHER 9a1. <br /> nFIXOTUKIIINISOWArNMENTSUMPTYPE O I.SINGLE WA L .DOVE4 WALL , 90.HaRg <br /> 7 171Yi' � j�' , •.r..,.,... <br /> 78NT P ARY CONTAMMW4T U 1.8TOBL 0. 01 PLAS71 90.NONH U 7%O HUR(SpW <br /> VANT SECONDARY CORCAR04BW C3 1.STEEL 13 4.FIR MOLASS 13 10.01010 PLASTIC 90.N0NH 99.OTHRR(6p3db) 9ae1 <br /> .0.f <br /> VR PRIMARY COMMENT 1.STEEL 0 9.PIBffiIt1LAE$ U 10.q 10 HY) 4 ! <br /> VR ROLV40ARY CONTAINMENT C3 1,STBSL N LPMMLABS 0 IO,RIGIO PLASTIC 0 90.NON9 Q 0.0VA_R(sWVy) <br /> 161h1 <br /> VONT PIP1N07RA P 013W L H L <br /> RIS IFIE YCONTAMMBNT I. TESL 4.FIBHROLASS IO.RIOMPLABTI I NONE <br /> RIFER MOND V TAMM NT I.STEEL 8 4,FL415ROLA93 U10.RIOM PLAYN 90,NONE C3 99,OTTIHt(Anetb) Y <br /> /akl <br /> PILL COMPON tNSTALLHD 1.VIM BUC88T 0 LBYRIIRDt PLAT81B PAOT /, ADIMpTS" w <br /> CONSTRUOTgN'T1T8 I.SIi0L3WALL 2.DOUBLE WALL Q LNO DISPENSBKB :'. U PO-NONECONSTRMMN MATERIAL i.STEEL Qq 4,PIEBR LASS 10.AIOD)PWSTIC 99,OTHER i <br /> 51931,OOMPONSNTPaGTBCTION C 2.6ACRIp(pALANODO(9) U 4.IMPREMED CURRENT 11 t.IBOLAMN <br /> CERTIBICATNA'U I CWV thAt 019 U87'q$WR N mtopalible with the hazard mhaunro stored and tlut the Itthtrma ion primedhatYa 4 true.aeolu9te, <br /> &Ad In hd Bama wUb I I Vitemenn. <br /> APPLICANTSIGNATURE DATE <br /> -4710/2012 An, <br /> APPLICANT NAME(print) I0gWa1L31 1' APPLICANTTInE Opa&ft <br /> UKT UST-8_1/3 VV P L J Z5(YIP� .(lye <br />