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.I UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION -TANK INFORMATION (One form per UST) TYPE OF ACTION (Check one item only: For a UST closure or removal,complete only this section and Sections L ll.//l,11;and Lf below) 411 ❑ L NEW PERMIT ❑ 3.RENEWAL PERMIT ® 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE 0 7.UST PERMANENT CLOSURE ON SITE 0 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 430a DATE EXISTING UST DISCOVERED: 4306 I. FACILITY INFORMATION FACILITY ID N(Agency Use Only) 1 BUSINESS NAME(Same as Facility Name or DBA-Doing Business.4s) 3 USA/Tesoro 68153 BUSLNESS-SITE 1013 CITY lw 2448 W. Kettleman Lane Lodi H. TANK DESCRIPTION TANK ID N 432 TANK MANUFACTURER 433 TANK CONFIGURATION:THIS TANK IS 434 3 � O I 1 •t Owens Corning ® 1.A STAND-ALONE TANK Complete un.page f.,mh ❑ 2.ONE IN A COMPARTMENTED UNIT wrnpantnt in the unit DATE UST SYSTEM INSTAI.I.ED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNITna437 1989 10,000 I 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 UmdOil) ❑ 5.EMERGENCY GENERATOR FUEL(fisc;25291 54c)) ❑ 6.OTHER GENERATOR_FUEL ❑ 95.UNKNOWN - ❑ 99.OTHER(Specify) 4392 CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ® Ib.PREMIUM UNLEADED 440 ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS 0 8.PETROLEUM_ BLEND FUEL ❑ 9 OTHER PETROLEUM_ (Spectfyl 4402 NON-PETROLEUM:❑ 7 USED OIL ❑ IO ETHANOL ❑ 11 OTHER NON-PETROLEUM(S ,�ifv) 440h IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1 SINGLE WALL ® 2.DOUBLE WALL ❑ 95.UNKNOWN 443 PRIMARY CONTAINMENT [II STEEL ® 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444 ❑ 7 STEEL+INTERNAL LINING ❑ 95 UNKNOWN ❑ 99.OTHER(Specify): 444. SECONDARY CONTAINMENT ❑ I STEEL ®3 FIBERGLASS ❑ 6 EXTERIOR MEMBRANE LINER ® 7 JACKETED 445 ❑ 90 NONE ❑ 95 UNKNOWN ❑99.OTHER l Jy1 445a. OVERFILL PREVENTION Q 1 \(DIBLE&VISU'AI ALARMS ❑ 2.BALL FLOAT ® 3.FILL TUBE SHUT-OFF VALVE 452 ❑ 4_I\NK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ I sl\(a L.\\,\1.1. ® 2 DOUBLE WALT_ ❑ 99.OTHER 460 SYSTEM TYPE - - -.... - ® I.PRESSURE ❑ : GRAVITY ❑ CONVENTIONAL SUCTION ❑ 4 SAFE SUCTION 123 CCR¢263«aX31) ssa PRIMARY CONTAINMENT ❑ 1 STEEL ® 4 FIBERGLASS ❑ 8 FLEXIBLE ❑ 10 RIGID PLASTIC 464 __ ❑ 90.NONE ❑ 9-5--UNKNOWN ❑ 99.OTHER(SpeciN). 464a SECONDARY CONTAINMENT ❑ 1 STEEL ® 4.FIBERGLASS ❑ 8 FLEXIBLE ❑ 10.RIGID PLASTIC 4646. ... -0 90 NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specityl 464c PIPING/ URBINE CONTAINMENT SUMP TYPE ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90 NONE 4644. 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): ` 464e1 VENT SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4 FIBERGLASS ❑ 10 RIGID PLASTIC ® 90.NONE ❑ 99 OTHER(Specify): 464f - - -- 464n VR PRIMARY CONTAINMENT ❑ I STEEL ® 4 FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 90.NONE ❑ 99.OTI(ER(Specify): 4648 - --. _._ - --- -- - ------- 464g1 VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4 FIBERGLASS ❑ 10.RIGID PLASTIC 90.NONH ❑ 99.OTHER(Specify): 064h ... .-- - - _ _ VENT PIPING TRANSITION SUMP TYPE ❑ 1 SINGLE WALL ❑ 2 DOUBLE WALL ® 90.NONE 4641 RISER PRIMARY CONTAINMENT -- -- ® I.STEEL ❑ 4 FIBERGLASS ❑ IU.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 4643 - _ -- 46431 RISER SECONDARY CONTAINMENT' ❑ I STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99 OTHER(Specify): 464k .. . . __ _ 464k1 FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET ® 3 STRIKER PLATE(BOTTOM PROTECTOR ® 4 CONTAINMENT SUMP 451a< VII. UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90 NONE 469. CONSTRUCTION MATERIAL ❑ 1 STEEL ❑ 4 FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99 OTHER(Specify) 4696. 069c VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ® 6 ISOLATION 44s IX. APPLICANT SIGNATURE CERTIFICATION: 1 certify that this UST system is compatible with the hazardous substance stored and that the information provided herein is true, accurate,and in full compliance with legal requirements. APPLICANT SIGNATURE S DATE 5/26/2010 470 APPLICANT NAME(print) Sandy Ed ands 471 APPLICANT TITLE Environmental Compliance 472 IIPCF LIST-B Rev.(12/M7)-1/2 www•.unidocs.org