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-Tf � UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUNDSTORAGETANK OPERATING PERMIT APPLICATION-TANK INFORMATION(one roan pi' US' TYPE OF ACTION (Check one item only. Form UST permanent closureor removal,complete only this section and�S�ecupnI.I�:BI,U1,IVa , nd IX below) 430 ❑ 1.NEW PERMIT ® 3.RENEWAL PERMIT El 8.UST r �(' IS RhYISTION F' 6.TEMPORARY UST CLOSURE 7.UST PERMANENT CLOSURE ON SITE DATE UST PERMANENTLY CLOSED: 43a DATE EXISTING UST DISCOVEREDF --_ 43M L FACILITY INFORMATION FACILITY ID a(Agency Use Only) _ 3 BUSINFS NAME( ACBdTY NAME or DBA-Doing Business As) - 3 - We-*_ itIZ -1 L'AV WggkN SAN JOAQUiJCOUIV7Y BUSINESS SITE AD ImCITY T.M l a �D Dr�I�UP YYIGn�[ C f h=AL [ a„ �P II.TANK DESCRIPTION TANK IC" .1 TANK MANUFACTURER 433 TANK CONDOURAMON: TIRSTANKIS 434 p -❑I STAND-ALONE TANK 1, I D�✓Q 3 .P J� (NONE INACOMPARTMENrED UNIT. DATE UST SYSSTErfgALLED us CO `�°"° bre.cs con, rie 0r war 11 ZZ `r�� TANK YINGALLONS 436 NUMBER OF COMPRTMENTS IN TBE UNIT 437 III.TANK USE AND CONTENTS TANK USE MO7'OR VEHICLE FUELING ❑ Ib.MARINA FUELING ElTo.AVIATION FUELING 439 K03,CHEMICAL PRODUCTSTORAGE ❑ 4.HAZARDOUS WASTE(n auem U e 0i9 ❑ 5.EMERGENCY GENERATOR FUEL pBc yzint.5(c)I [:16.OTHER GENERA FUEL ❑ 95.UNKNOWN ❑ 99 OTHER(Specify): 439e CONTENTS PETROLEUM AR UNLEADED ❑ Ic.MIDGRADE UNLEADED ❑ Ib.PREMIUM UNLEADED 440 DB SEL Q 5.JET FUEL ❑6.AVIATION GAS U 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM S 4dQa NON-PETROLEUM ❑ 7.USED OIL Q 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM S - a4ab IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL 2.DOUBLE WALL ❑ 95.UNKNOWN N3' PRIMARY CONFAINME6IT ❑ 1.STEEL 3.FIBERGLASS Q 6.INTERNAL BLADDER 441 19 7.S'i'EET,+INTERNALLINMG Q 95.UNKNOWN ❑ 99.OTTER 9 M44 SECONDARY CONTABJhB.N'r Q L STEEL 03 FIBERGLASS 6.EXTERIOR MEMBRANE Q 7.3ACKEIED 415 Fl 90. NE ❑ 95.UNKNOWN 99.OTHER S eci W. OVERFILL PREVENTION .AUDIBLE&VISUAL ALARMS 2.BALL FLOAT .FILL TUBE SHUT-OFF VALVE 452 ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT K PRODUCT/ PIPING CONSTRUCTION PBINGCONSFRIKTAO ❑LSINGLEWALLED UBL&WALLED Q99.OTHEIt SYSTEMIYPE - 460 URE ❑ 2 ]BwITY Q 3.CONVENTTONAL SUCTION 4 .S .SAFE SUCTION 23Crng p 456 PRBAARY CONTA64MENT Q 1TEEL BERGLASS ❑ 8.FLEXBLE ❑ 10.RIGm PLASTIC 464 ❑ 90.NONE Q 95.UNKNOWN 1399.OTHER(Spm ): a6aa SECONDARY CON I ABVMENT ❑ L STEEL . BERGLASS ❑ 8.FLEXIBLE ❑ I0.RIGID PLASTIC 4616 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 4Nc PBD1G?URBINE CONI'AR4hBNT SUMP TYPE GLE WALL 2.DOUBLE WALL 1`190 NONE 4644 VI.VENT,VAPOR RECOVERV(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINIvBNT LSTEEL ❑ 4.FBERGLAS3 ❑ IO.RIGB3 PLASTIC ❑ 90.NONE ❑ 99.OTHER(Sp-dry) oboe VENT SECONDARY CONTAINMENT _ 1.STEEL 4.FIBERGLASS ❑ t0.RIGID PLASTIC 461e1 Ile Q 90.NONE ❑ 99.OTHER 464f VR PRIMARY CONTAINMENT J/T I.STEEL 4.FBERCLASS 10.BRAD PLASTIC 90,NONE 99.0'ITBIt(Speary) �e O64 1 VR SECONDARY CONTAINMENT 4 1.STEEL m 4.FBPRGLASS ❑ 10.RIGID PLASTIC 90.NO E ❑ 99.GTHER($prr4fy) 4�6 VENT PIPING TRANSITION SUMP TYPE I.SINGLEWALL 2.DOUBLE WALL 464h1 RISER PRIMARY CONTAB4hBNF' 1.377iEL 4.PBERGI-ASS 10.RIGID PLASTIC 90.NONE 99.017♦FR(Spaify) 46ij RISER SECONDARY CONTAINMENT 1.STUB, 4.FEBERGLASS 10.RIGm PLA3TK' .NONE 464 I 90 ❑ "OTHER(Spedfy) 4644 FILL COMPONENT'S INSTALLED US L SPILL BUCKET 3.STRIKER PLA'I'F1B0'ETOM PROTECTOR 4.CONTAB4hBNT SOME 45 lel UNDLR DISPENSER f'_<WTAINMENT(pDC) CONSTRUCTION TYPE .S E WALL RUBLE WALL ❑ 3.NO DISPENS6R3 CANSTRUCITON MAFERIAI. TEFL 4.FIBERGLASS ❑ 90.NONE ass' �Q to.RIGID PLASTIC 99.UrBER Se.14696s VUL CORROSION PROTECTION $FEET.COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODEO) ❑ 4.IMPRESSED CURRENT . SOLATION 448. OL APPLICANT SIGNATURE CRRTTFICATION: I certHy that this UST system is compatible With the hazardous sR finace stored and that the information provided herein is true,accurate, and in lull cum Iiance with 1 at irememb. APPLICANT SIGNA 47D DATE �� S_ 'Z.O� APPLICANT NA �ct� PDm)F✓'a/U LYGN'P �e�lnw. VL APPLICANT y�GCI 4n BlCP In � Completed .� .....�. Y.I(yiVV/I