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tTl INIHIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION (One form per(1ST) TYPE OF ACTION (Check one item only. For a UST closure or removal,complete only this section and Sections 1,11111 It',and U'below) 430 ❑ I.NEW PERMIT ❑ 3.RENEWAL PERMIT 6.TEMPORARY UST CLOSURE 7.UST PERMANENT CLOSURE ON SITE ® .5.CHANGE OF INFORMATION DATE UST PERMANENTLY CLOSED: 430e [1 8.UST REMOVAL DA"TE EXISTING UST DISCOVERED: 4301, I. FACILITY INFORMATION FACILITY ID H(Agenc),Use Only) 1. BUSINESS NAME(Same as Facility Name or DBA-Doing Business A.0 1 USA/Tesoro 68153 BUSINESS SITE ADDRESS ^1 CITY 2448 W. Kettleman Lane Lodi II. TANK DESCRIPTION TANK ID H (�q Q 1472 TANK MANUFACTURER 43) TANK CONFIGURATION:THIS TANK IS +34 2A� I/'1 Nl 4SOG Owens Corning 0 1.A STAND-ALONE TANK Complete one page for each ❑ 2.ONEINA COMPARTMENTED UNIT conipanment to the unit DATE UST SYSTEM INSTALLED 415 TANK CAPACITY IN GALLONS 446 NUMBER OF COMPARTMENTS IN THE UNIT 437 1989 10,000 I III. TANK USE AND CONTENTS TANK USE ® la.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ Ic.AVIATION FUELING 439 ❑ 1.CHEMICAL PRODUCT STORAGE. ❑ 4.HAZARDOUS WASTE(Includa Uxd Oil) [I 5.EMERGENCYGENERATOR FUEL)HSC 425281 5(c)] ❑ 6.OTHER GENERATOR FUEL ❑ 95.L`K.NOWN ❑ 99.OTHER(Specify): 439a EN CONTTS PETROLEUM ❑ la.REGULAR-UN LEADED El Ic.MIDGRADE UNLEADED ❑ Ib.PREMIUM UNLEADED 4+0 ❑ 3.DIESEL ❑ 5 JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM_ BLEND FUEL ❑ 9 OTHER PETROLEUM(Specify): 44pa NON-PETROLEUM:❑ 7 USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEU%I(Specify) 440b IV. TANK CONSTRUCTION TYPE OF TANK ❑ I.SINGLE WALL ® 2 DOUBLE WALL ❑ 95 UNKNOWN 443 PRIMARY CONTAINMENT ❑ 1 STEEL ® 3 FIBERGLASS ❑ 6 INTERNAL BLADDER 444 ❑ 7 STEEL�INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 444a. SECONDARY CONTAINMENT ❑ 1.STEEL ®3 FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ® 7.JACKETED -- -----als ❑ 90.NONE ❑ 95.UNKNOWN ❑99_OTHER ISpecify): 445■ OVERFILL PREVENTION ❑ 1 AUDIBLE&VISUAL ALARMS ❑ 2 BALL FLOAT ® 3.FILL TUBE SHUT-OFF VALVE +52 ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ 1.SINGLE WALL. ® 2 DOUBLE WALL. ❑ 99.OTHER 460 SYSTEM TYPE -- - ® I.PRESSURE ❑ 2 URA\'IT}' ❑ 3.CONVENTIONAL SE'C'TION ❑ 4.SAFE SUCTION_123 CCR§2636(ax3)1 458 PRIMARY CONTAINMENT ❑ 1.STEEL ® 4 FIBERGLASS ❑ 8.FLEXIBLF. ❑ 10.RIGID PLASTIC +a4 ❑ 90 NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify) 464a Y CON SECONDARTAINMENT ❑ I.STEEL ® 4 FIBERGLASS C18.FLEXIBLE ❑ 10 RIGID PLASTIC 464b ❑ 90 NONE ❑ 95 UNKNOWN ❑ 99.OTHER(SpeciR,). 364a PIPINGfrURBINE CONTAINMENT SUMP TYPE ® I.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464d VI. VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ 1.STEEL ® 4 FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90 NONE ❑ 99.OTHER ISpecifi C' fie ..-- -. -. ---- - - - x$40. VENT SECONDARY CONTAINMENT ❑ I STEEL ❑ 4.FIBERGLASS ❑ 10 RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): - - 464n VRPRIMARY CONTAINMENT ❑ L STEEL ® 4 FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90 NONE [199.OTHER(Specify)_ 4664% VR SECONDARY CONTAINMENT ❑ 1 STEEL ❑ 4.FIBERGLASS ❑ 10 RIGID PLASTIC ® 90.NONE ❑ 99 OTHER(Specify): 4641h VENT PIPING TRANSITION SUMP TYPE ❑ I SINGLE WALL [12.DOUBLE WALL ® 90.NONE 4+641 RISER PR IMARY CONTAINMENT ® I STEEL ❑ 4 FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): J6411 4641 RISER SECONDARY CONTAINMENT ❑ 1.STEEL El4.FIBERGLASS ❑ 10 RIGID PLASTIC ® 90.NONE ❑ 99 OTHER(Specify): 464k J464 FILL COMPONENTS INSTALLED ® L SPILL BUCKET ® 3.STRIKER PLATE/BOTTOM PROTECTOR ® 4.CONTAINMENT SUMP 451.- VII. UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ® I.SINGLE WALL ❑ 2 DOUBLE)PALL ❑ 3 NO DISPENSERS ❑ 90 NONE 4690 CONSTRUCTION MATERIAL ❑ I.STEEL ❑ 4 FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 46"b J69C VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT' ® 6.ISOLATION 448 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 full com liance with leeal re uirements. APPLICANT SIGNATURE S DATE 5/26/2010 470 APPLICANT NAME(print) Sandy Ed ardS 471 APPLICANT"TITLE Environmental Compliance 472 UPCF UST-B Rev.(12/2007)-1/2 www.uniJ0cx.0r�