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r1 UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION tone form per UST( TYPE OF ACTION (Check one item only. For a UST'closure or removal,complete only this section and Sections 111,111,If.and LV below) 4 t, ❑ ].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: 430■ 1 DATE EXISTING UST DISCOVERED: 430h I. FACILITY INFORMATION FACILITY ID#(:(gene),Use Only) 1 BUSINESS NAME(Same as Facility Mame or DBA-Doing Business.4s) , USA/Tesoro 68153 BUSINESS SITE ADDRESS 103 CRY 104 2448 W. Kettleman Lane Lodi II. TANK DESCRIPTION TANK ID# 432 TANK MANUFACTURER 433 TANK CONFIGURATION:THIS TANK IS 434 1 #� 0194$0 Owens Coming ® 1 A STAND-ALONE TANK Complete one page for each ❑ 2 ONE IN A COMPARTMENTED UNIT =ompanment to the unit DATE UST SYSTEM INSTALLED 49S TANK CAPACITY IN GALLONS J16 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 479 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL(HSC 25281 5(c ❑ 6 OTHER GENERATOR FUEL ❑ 95.UNKNOWN _ ❑ 99.OTHER(Specify): t7aa CONTENTS PETROLEUM: ® Ia.REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ❑ Ib.PREMIUM UNLEADED 4a0 ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM(Specify): 440a NON-PETROLEUM❑ 7 USFD OIL-_' -- ❑ IQ ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify) 4401, IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALT. ® 2.DOUBLE WALL ❑ 95.UNKNOWN_ 443 - -- - -- - - PRIMARY CONI'AINMENT ❑ I STEEL ® 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 4" ❑ 7 STEEL+INTERNAL LINING_ ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 444a SECONDARY CONTAINMENT ❑ 1 STEEL ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ® 7 JACKETED a45 ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specih) 445c OVERFILL PREVENTION ❑ 1 AUDIBLE&VISUAL ALARMS ❑ 2 BALL FLOAT ® 3.FILL TUBE SHUT-OFF VALVE 452 4 'LINK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ I-SINGLE WALL ® 2 DOUBLE WALL ❑ 99.OTHER 4� SYSTEM TYPE ® I.PRESSURE ❑ 2 GRAVfTY [13 CONVENTIONAL SU'C'TION C34.SAFE SUCTION 123 CCR§26)64ax3>I 4<a PRIMARY CONTAINMENT ❑ I.STEEL ® 4 FIBERGLASS ❑ 8 FLEXIBLE ❑ 10 RIGID PLASTIC 4b4 ❑ 90 NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464a SECONDARY CONTAINMENT ❑ I STEEL ® 4 FIBERGLASS ❑ S.FLEXIBLE ❑ 10.RIGID PLASTIC 464b ❑ 90.NONE ❑ 95 UNKNOWN ❑ 99 OTHER(Specifv) 464 PIPING/TURBINE CONTAINMENT SUMP TYPE ® 1.SINGLE WALL ❑ 2.DOL"BLF%%,\LL ❑ 90.NONE 464d 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): 464e VENTSECONDARY CONTAINMENT ❑ 1 STEEL [14.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE [199.OTHER(Specify): 464f __ .. . _ -- - - - - awn VR PRIMARY CONTAINMENT ❑ 1.STEEL 0 4 FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90 NONE ❑ 99.OTHER(Specify) 464g VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specth) 464h VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE 4641. RISER PRIMARY CONTAINMENT ® L STEEL ❑ 4 FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90 NONE ❑ 99.OTHER(Specify): 464) --- - 464j1 _ RISER SECONDARY CONTAINMENT [1I.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 464k 46441 FILL COMPONENTS INSTALLED ® 1 SPILL BUCKET ® 3 STRIKER PLATE/BOTTOM PROTECTOR ® 4 CONTAINMENT SUMP r51a c VII. UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE. ® 1 SINGLE WALL ❑ 2 DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469a CONSTRUCTION MATERIAL" ❑ 1 STEEL ❑ 4.FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 99.OTHER(Specify) 46% 469c VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4 IMPRESSED CURRENT ® 6.ISOLATION 443 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 re uirements. APPLICANT SIGNATUR ( S DATE 5/26/2010 470 APPLICANT NAME(print) Sandy Edwards ` 471 APPLICANT TITLE Environmental Compliance 472. UPCF UST-B Rev.(1212007)-1/2 www.oaidoes.org