BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

U IED PROGRAM CONSOLIDATED FORre 01 UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION -TANK INFORMATION (one'-per 1 s r) n TYPE OF ACTION (Check one item only. For a UST closure or removal,complete only this section and Sections 1.11.111.1V,and IY below) ❑ I.NEW PERMIT ❑ 3.RENEWAL PERMIT ® 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE (:1 8.UST REMOVAL DATE UST PERMANENTLY CLOSED 4303 1 DATE EXISTING UST DfSCOVERED: 4306 I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) BUSINE Facility Name or DBA-Doing Business As) ? esoro/Shel16 cid t**c wm USA Cv% StA•ri* 6 ,53 c ire �� e!1 eS±va b�Cls� ADDRESS 103 C'f1'Y 104 2448 W. Kettleman Lane Lodi II. TANK DESCRIPTION TANK ID N 132 TANK MANUFACTURER 433 TANK CONFIGURATION:THIS TANK IS 434 (� � b Iq 906 Owens Coming ® 1.A STAND-ALONE TANK Complete one page for each ❑ 2.ONE IN A COMPARTMENTED UNIT compartment in the unit DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 476 NUMBER OF COMPARTMENTS IN THE UNIT 437 1989 10,000 1 III. TANK USE AND CONTENTS TANK USE ® Ia.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ Ic.AVIATION FUELING ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(I.I dea Used Oiq ❑ 5.EMERGENCY GENERATOR FUEL[HSC§25231 5(c)] ❑ 6.OTHER GENERATOR FUEL _ ❑ 95.UNKNOWN _❑ 99.OTHER(Specify): 439& CONTENTS PETROLEUM: ❑ 1 a.REGULAR UNLEADED ® Ic.MIDGRADE UNLEADED ❑ I b.PREMIUM UNLEADED 440 ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6 AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM(Specify): _`40& NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 440b IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 95.UNKNOWN 443 PRIMARY CONTAINMENT ❑ 1.STEEL ® 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444 _ ❑ 7.STEEL+R4TERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER(Spmfy). -444a. SECONDARY CONTAINMENT ❑ 1 STEEL ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ® 7.JACKETED 445 ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specify): 445& OVERFILL PREVENTION _ ❑ 1 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 PRESSURE_ 0 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION-❑ 4.SAFE SUCITON[23 CCR¢2636(ax7)J _ 453 PRIMARY CONTAINMENT ❑ I STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10_RIGID PLASTIC 464 ❑ 90.NONE ❑_95.UNKNOWN _❑ 99.OTHER(Specify): 464a` SECONDARY CONTAINMENT ❑ L STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE i ❑ 10.RIGID PLASTIC 464b ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c PIPINGlTURBINE CONTAINMENT SUMP TYPE ® 1.SINGLE WALL ❑ z DOUBLE WALL ❑ 90.NONE Wd VI. VENT,VAPOR RECOVERY (VR) AND RISER/FILL PIPE PIPING CONSTRUCTION VENPRIMARY CONTAINMENT ❑ L STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99L OTHER(Specify): 4� T' j VENT SECONDARY CONTAINMENT [11.STEEL [34.FIBERGLASS [310.RIGID PLASTIC ® 90.NONE [399.OTHER(Specify): 4641 f VR PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 446 g VR SECONDARY CONTAINMENT [3 L STEEL ❑ 4.FIBERGLASS [110.RIGID PLASTIC _® 90.NONE ❑ 99.OTHER(Specify): 4644k1 VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE ` RISER PRIMARY CONTAINMENT ® L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99,OTHER(Specify): q j_ RISER SECONDARY CONTAINMENT [3L STEEL [34.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 46 44kk FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET ® 3.STRIKER PLATEIBOTTOM PROTECTOR ® 4.CONTAINMENT SUMP 4511-c - VII. UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ® 1.SINGLE WALL_ i ❑ 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 4693 CONSTRUCTION MATERIAL [II STEEL ❑ 4 FIBERGLASS [1l0.RIGID PLASTIC [199.OTHER(Specify) O9b VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL.ANODE(S) ❑ 4.IMPRESSED CURRENT ® 6.ISOLATION 143 IX. APPLICANT SIGNATURE CERTIFICATION: I certify that this UST system is compatible with the hazardous substance stored and that the information provided herein is true, accurate and in fullcompliance liance with legal requirements. APPLICANT SIGNATURE i CCL-0 S DATE 1/13/2011 4-0 APPLICANT NAME(print) Sandy Ed ardS 4�1 APPLICANT TITLE Environmental Compliance 4'2 UPCF UST-B Rev.(12/2007)-112 www.unidoes.org