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AZ- TED PROGRAM CONSOLIDATED FOR c1 UNDERGROUND STORAGE TANK -f'�-(I OPERATING PERMIT APPLICATION -TANK INFORMATION (one fonn per UST) K� TYPE OF ACTION (Check one item only. For a LIST closure or removal,complete only this section and Sections 1,11.111.it',and IX below) 430 W PEI I ( l ❑ I.NEW ❑ 3-RENEWAL PERMIT ® 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7. UST PERMANENT CLOSURE ON SITE 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 4304 1 DATE EXISTING UST DISCOVERED: 4306 I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) _ - 6 I BUST a as Facility Name or DBA-Doing Business As) 3 esoro/Shell 68153 cid NxK kyq USA C-it STIITuN -4�CrS3 BU SS SITE ADDRE 103 CITY 104 244 e t e-man Lane Lodi II. TANK DESCRIPTION TANK ID# 432 TANK MANUFACTURER 433 TANK CONFIGURATION:THIS TANK IS 434 '��®19 Sb4 Owens Corning ® 1.A STAND-ALONE TANK Complete one page for each ❑ 2.ONE IN A COMPARTMENTED UNIT comp&nment in the unit DATE UST SYSTEM INSTALLED 415 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 1989 10,000 1 III. TANK USE AND CONTENTS TANK USE ® la.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ Ic.AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL(HSC§25291.5(c)) _ ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 439& CONTENTS PETROLEUM- ❑ 1a.REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ® Ib.PREMIUM UNLEADED 440. ❑ 3.DIESEL ❑ 5.JET FUEL. ❑ 6.AVIATION GAS ❑ 8.PETROLEUM_BLEND FUEL ❑ 9.OTHER PETROLEUM(Specify): 440&. NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(S i ): 440 IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 95.UNKNOWN 443 PRIMARY CONTAINMENT ❑ I.STEEL ® 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444 _ ❑ 7.STEEL+INTERNAL LIMNG ❑ 95.UNKNOWN ❑ 99.OTHER ISpecify): 444a SECONDARY CONTAINMENT [11.STEEL v�0 3 FIBERGLASS _❑ 6.EXTERIOR MEMBRANE LINER ® 7.JACKETED 445 ❑ 90.NONE ❑ 95.UNKNOWN_ (:199.OTHER(Specify): 445a OVERFILL PREVENTION ❑ L AUDIBLE&VISUAL ALARMS ❑ 2.BALL FLOAT ® 3.FILL TUBE SHUT-OFF VALVE 452 ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ I.SINGLE WALL ® 2.DOUBLE WALL ❑ 99.OTHER 460. SYSTEM TYPE ® 1.PRESSURE0 2.GRAVITY ❑ 3.CON_VENTIO_NAL SUCTION [3_A.SAFE SUCTION[23 Mt§2636(&x3)1 459 PRIMARY CONTAINMENT ❑ 1 STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10,RIGID PLASTIC 464 ❑ 90.NONE _ ❑ 95.UNKNOWN_ ❑ 99.OTHER(Specify): 464x. SECONDARY CONTAINMENT ❑ I.STEEL 04.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10 RIGID PLASTIC 4Wb- __ ❑ 90-NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c. PIPING/TURBINE CONTAINMENT SUMP TYPE ® 1 SINGLE WALL ❑ 2-DOUBLE WALL ❑ 90.NONE VI. VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ I.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify):: 64 _ 464x1 VENT SECONDARY CONTAINMENT [31.STEEL [34.FIBERGLASS [310.RIGID PLASTIC 0 90.NONE ❑ 99.OTHER(Specify): ,y6in VR PRIMARY CONTAINMENT ❑ I.STEEL ® 4.FIBERGLASS E3 to.RIGID PLASTIC [39o.NONE E399.OTHER(Specify) 4649. VR SECONDARY CONTAINMENT ❑ I.STEEL ❑ 4.FIBERGLASS 13 to.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 40t _..-. -..-... _..___._.- �-...« 46461 VENT PIPING TRANSITION SUMP TYPE _ ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE 'fit RISER PRIMARY CONTAINMENT ® I STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 464 y�j RISER SECONDARY_CONTAINMENT ❑ I STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 46601 FILL COMPONENTS INSTALLED ® I SPILL BUCKET 19 3.STRIKER PLATFJBOTTOM PROTECTOR ® 4.CONTAINMENT SUMP 451s=i.- VII. UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE _ __ ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE469& CONSTRUCTION MATERIAL ❑ 1.STEEL ❑ 4 FIBERGLASS [310.RIGID PLASTIC ❑ 99.OTHER(Specify) - 4 . VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ ` SACRIFICIAL ANODE(S) ❑ 4 IhIPRESSED CURRENT ® 6 ISOLATION 449 IX. APPLICANT SIGNATURE CERTIFICATION: 1 certify that this UST system is compatible with the hazardous substance stored and that the information prvwided herein is true, accurate,and in full compliance with legal requirements. APPLICANT SIGNATURE S DATE 1/13/2011 470 APPLICANT NAME(print) Sandy Ed ardS 471 APPLICANT TITLE Environmental Compliance 47' UPCF UST-B Rev.(12/2007)-1/2 www.unidocs.org